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Surgical treatment of total anomalous pulmonary venous connection —Clinical aspects of pulmonary venous obstruction—

  • Katsunori Yoshihara
  • Tsukasa Ozawa
  • Hiroshi Sakuragawa
  • Takeshirou Fujii
  • Noritsugu Shiono
  • Yoshinori Watanabe
  • Nobuya Koyama
  • Hiroyuki Matsuura
  • Tsutomu Saji
  • Yoshinori Takanashi
Original Article

Abstract

During November 1986 and May 1997, 19 patients with total anomalous pulmonary venous connection (TAPVC) underwent repair surgery. 20 operations including two reoperations were performed. 8 of 19 patients were classified as Darling type Ia, 5 as type IIa, 4 as type III and 2 patients were type IV. Two patients were operated under emergency circumstances within 24 hours after admission, 7 patients were after a short term stabilization of 4.4 days, and the other 11 patients received surgical treatment after a mean of 8.8 days as scheduled cases. For the anostomosis, the common pulmonary venous chamber or the vertical vein was connected with the left atrium in type Ia and III cases; in type IIa and IV cases the cut-back method was performed. Persistent pulmonary hypertension and post-operative pulmonary venous obstruction (PVO) affected the post-operative clinical course. Persistent pulmonary hypertension caused the death of one patient with type IIa and III each, just after operation. One type IV patient died 50 days after operation. The autopsy revealed post-operative obstructions of the remote parts of the pulmonary veins on the anostomosis site. Two patients (type IIa, III) successfully underwent reoperation due to PVO. Post-operative cardiac catheterization was performed after 12 month in 12 cases. Persistent pulmonary hypertension was found in 4 patients, and a type III patient was reoperated because of stenosis of the anostomosis site. The other three patients had persistent pulmonary hypertension without any demonstrable PVO. Persistent pulmonary hypertension and PVO are combined as TAPVC complex. The difficulty to reoperated patients with persistent pulmonary hypertension caused by PVO is one major problem. So preoperative prevention of PVO by normalization the morphologic changes of the pulmonary veins by using drugs could be a different view point in TAPVC therapy after the initial operation.

Keywords

Pulmonary Vein Short Term Stabilization Persistent Pulmonary Hypertension Total Anomalous Pulmonary Venous Connection Pulmonary Venous Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 1998

Authors and Affiliations

  • Katsunori Yoshihara
    • 1
  • Tsukasa Ozawa
    • 1
  • Hiroshi Sakuragawa
    • 1
  • Takeshirou Fujii
    • 1
  • Noritsugu Shiono
    • 1
  • Yoshinori Watanabe
    • 1
  • Nobuya Koyama
    • 1
  • Hiroyuki Matsuura
    • 1
    • 2
  • Tsutomu Saji
    • 1
    • 2
  • Yoshinori Takanashi
    • 1
    • 3
  1. 1.Department of Thoracic Cardio Vascular SurgeryToho University School of MedicineTokyoJapan
  2. 2.The First Department of PediatricsToho University School of MedicineTokyoJapan
  3. 3.Department of Pediatric Cardio Vascular Surgery, The Heart Institute of JapanTokyo Women’s Medical CollegeTokyoJapan

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