Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 3-4, Pages: 164-169
https://doi.org/10.2298/SARH1404164M
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Outcomes of surgery for total anomalous pulmonary venous drainage
Milovanović Vladimir (Pediatric Cardiac Surgery Department, University Children’s Hospital, Belgrade)
Mimić Branko (Pediatric Cardiac Surgery Department, University Children’s Hospital, Belgrade)
Vulićević Irena (Pediatric Cardiac Surgery Department, University Children’s Hospital, Belgrade)
Divac Ivan (Pediatric Cardiac Surgery Department, University Children’s Hospital, Belgrade)
Parezanović Vojislav (Faculty of Medicine, Belgrade + Pediatric Cardiology Department, University Children’s Hospital, Belgrade)
Ilisić Tamara (Pediatric Cardiology Department, University Children’s Hospital, Belgrade)
Đukić Milan (Faculty of Medicine, Belgrade + Pediatric Cardiology Department, University Children’s Hospital, Belgrade)
Jovanović Ida (Faculty of Medicine, Belgrade + Pediatric Cardiology Department, University Children’s Hospital, Belgrade)
Ilić Slobodan (Pediatric Cardiac Surgery Department, University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Introduction. Total anomalous pulmonary venous connection (TAPVC) is a rare
congenital heart disease and in some variants represents the only true
surgical emergency in congenital heart surgery. Basic anatomical
characteristic of this anomaly is an abnormal connection of pulmonary veins
with systemic venous circulation. Although the results of TAPVC repair in
infancy have been markedly improved in recent years, the recurrent pulmonary
venous obstruction (RPVO) remains relatively frequent complication of
surgical treatment. Objective. The aim of this study was a retrospective
evaluation of TAPVC repair at a single institution, identifying the risk
factors associated with the increased mortality and morbidity. Methods.
Between January 2001 and January 2010, 43 consecutive patients underwent
repair of TAPVC at the University Children’s Hospital, with median weight of
3.8 kg (1.8-13 kg). Median age at surgery varied from 5 days to 5 years.
Distribution of TAPVC types was as follows: supracardiac 19 (44%), cardiac
12 (28%), infracardiac 9 (21%), and mixed 3 (7%). Eleven patients (26%) were
emergencies due to obstructed drainage. Results. Early mortality was 9.30%
(4/43). An average time of followup/survival for 95% interval of confidence
was 101.6±6.7 months. Kaplan-Meier cumulative survival was 83.7±5.7%.
Freedom from reintervention after 10 years was 87.2±0.5%. The principal
reason for reintervention was RPVO. Conclusion. Preoperative obstruction is
not a risk factor of early mortality and RPVO. Low body mass (below 2.5 kg)
is the only identified risk factor of early mortality. Complex morphology of
the confluens, particularly in a mixed type of TAPVR, is the main risk
factor of RPVO development.
Keywords: total anomalous pulmonary venous connection, congenital heart disease, results of surgical repair