In situ relief of postrepair pulmonary venous obstruction using the endocardial anchoring technique.
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ABSTRACT:
SUBMITTER: Yamamoto Y
PROVIDER: S-EPMC11329171 | biostudies-literature | 2024 Aug
REPOSITORIES: biostudies-literature
Publications
In situ relief of postrepair pulmonary venous obstruction using the endocardial anchoring technique.
Yamamoto Yusuke Y Akiyama Sho S Hotoda Kentaro K Noma Mio M Yamaguchi Shuhei S Nagamine Hiroki H Maeda Jun J Yoshimura Yukihiro Y
JTCVS techniques 20240427
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Project description:Postoperative pulmonary venous obstruction after the repair of total anomalous pulmonary venous connection is a challenging complication, especially when it occurs in the upstream pulmonary vein outside the pericardial sac. Here, we report such a case that was resolved successfully by a novel, modified, sutureless technique that repositioned the pericardial reflection to expand the pericardial sac.
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Project description:We present a case of D-transposition of great arteries with atrial septal defect and patent ductus arteriosus electively posted for Senning's operation at 10 months of age. The patient developed signs of lung congestion immediately after termination of cardiopulmonary bypass. A stenosis in the pulmonary venous baffle was detected in transesophageal echocardiography showing a peak gradient of 10 mmHg and a mean gradient of 5 mmHg. Hence, revision of baffle was planned. The stenotic area was excised and augmented with homologous pericardium. Post-correction, lung compliance improved and the peak and mean gradient decreased to 3 and 1 mm Hg, respectively. The patient was extubated in the intensive care unit after 36 h and shifted to ward after 5 days with stable hemodynamics.
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Project description:ObjectivesA meta-analysis was performed to investigate the risk factors for postoperative pulmonary venous obstruction (PVO) after surgical repair of total anomalous pulmonary venous connection (TAPVC).MethodsData bases including PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The goal was to discuss the risk factors for postoperative PVO after TAPVC. Publications were screened by 2 authors independently for criteria inclusion, methodological quality assessment and data extraction. The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality checklist were obtained to assess the quality of the studies. Data were pooled by the random effect model or the fixed effect model according to the heterogeneity test.ResultsA total of 16 studies (2,385 participants) were included in the meta-analysis. All included studies were retrospective studies. Six potential risk factors were pooled, 5 of which were significantly associated with postoperative PVO. Patients with preoperative PVO were more likely to suffer from postoperative PVO [odds ratio (OR)=5.27, 95% confidence interval (CI) = (2.75, 10.11), P < 0.01]. Compared with a sutureless procedure, the conventional operative procedure was associated with postoperative PVO [OR = 1.80, 95% CI=(1.20, 2.71), P < 0.01]. A mixed type TAPVC plays a critical role in postoperative PVO [OR = 3.78, 95% CI=(1.08, 13.18), P = 0.04]. Inverse variance analysis showed that longer cardiopulmonary bypass time [hazard ratio (HR)=1.01, 95% CI=(1.01, 1.02), P < 0.00001] and aortic cross-clamp time [HR = 1.01, 95% CI=(1.01, 1.02), P < 0.01] were significantly associated with postoperative PVO. Heterotaxy [OR = 1.18, 95% CI = 0.13, 10.45, P = 0.88] was not statistically significant as a risk factor for postoperative PVO.ConclusionsThis meta-analysis may provide a perspective on the risk factors for postoperative PVO after TAPVC, thus leading to more studies predicting postoperative PVO after TAPVC with our findings.
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Project description:ObjectiveA review of our center's experience before March 2011 showed that one half of 36 patients who had a baffling or reimplantation procedure to repair scimitar syndrome developed pulmonary vein obstruction. We analyzed the results of a new operation that enlarges the left atrium and avoids circuitous pathways or tension on the scimitar pulmonary vein.MethodsBetween April 2011 and November 2018, 22 patients underwent scimitar vein surgery; 11 had baffling or reimplantation and 11 only had the new operation that included resection of the atrial septum with removal of the muscular limbus. The left atrium was pulled down toward the scimitar vein and a V-shaped incision made at the scimitar vein atrial junction with the space filled with a pulmonary homograft. If the scimitar vein coursed adjacent to the atrium, a V-shaped incision was made into the scimitar vein and directly anastomosed to the atrium. A patch of autologous pericardium was used to septate the atrium and an additional patch placed anteriorly to augment the inferior vena cava.ResultsOf the 11 patients who had baffling or reimplantation, 5 developed pulmonary vein obstruction between 45 days and 9.5 months after surgery associated with baffle thrombosis or tension on the pulmonary vein. None of the 11 patients who only had the new procedure developed pulmonary vein obstruction during postoperative monitoring up to 3.6 years.ConclusionsPatients having only the multipatch procedure for repair of scimitar syndrome have not developed postoperative pulmonary vein obstruction in the short to intermediate term.
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Project description:Nonthrombotic iliofemoral venous obstruction, masquerading as deep vein thrombosis, was diagnosed in four patients. In each instance the patient was hospitalized and intravenous heparin therapy was started. Phlebography demonstrated venous outflow obstruction without thrombosis; subsequent CT scanning revealed an obstructing lesion in each case. At surgical exploration, (1) endoaneurysmorrhaphy of a hypogastric artery aneurysm decompressed an obstructed right iliac vein; (2) a primary iliac vein leiomyosarcoma was extirpated; (3) a synovial cyst arising from the right hip joint, which obstructed the femoral vein, was excised; and, (4) a postherniorrhaphy inflammatory mass obstructing the left iliofemoral vein junction was confirmed with biopsy results. Improved diagnostic accuracy with its attendant specific therapy is achieved in suspected cases of iliofemoral vein thrombosis if, in addition to noninvasive venous studies or phlebography, CT scanning of the abdomen and pelvis is performed.
| S-EPMC10131839 | biostudies-literature
Project description:We present the case of an infant with total anomalous pulmonary venous connection and a branching vertical vein with multiple points of narrowing, draining the confluence into the innominate vein. The embryology and clinical relevance of this interesting anatomy is discussed.
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Project description:BackgroundModified L-shaped incision technique (MLIT) was successfully applied to the repair of supracardiac total anomalous pulmonary venous connection (TAPVC) with promising mid-term outcomes. It is, however, unclear whether or not MLIT could be an alternative to sutureless technique (ST).MethodsAll patients (n=141) who underwent MLIT or ST repair for supracardiac TAPVC between June 2009 to June 2022 were included and a propensity score-matched analysis was performed to reduce the heterogeneity.ResultsMLIT was performed in 80.9% (114/141), whereas ST was performed in 19.1% (27/141). Patients who underwent MLIT repair had a lower incidence of pulmonary veinous obstruction (PVO)-related reintervention (1.8% vs. 18.5%, P=0.002), and late mortality (2.6% vs. 18.2%, P=0.006). Overall survival at 10 years was 92.5% (87.7%-97.7%) for MLIT and 66.8% (44.4%-100%) for ST (P=0.012). Freedom from postoperative PVO at 10 years was 89.1% (83.2%-95.5%) for MLIT and 79.9% (65.6%-97.4%) for ST (P=0.12). Cox proportional hazards regression identified prolonged mechanical ventilation duration, postoperative PVO, respiratory dysfunction and low cardiac output syndrome were associated with postoperative death and PVO-related reintervention.ConclusionsThe MLIT strategy is a safe, technologically feasible, and effective approach for supracardiac TAPVC, which is associated with more favourable and promising freedom from death and PVO-related reintervention.
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| S-EPMC9270664 | biostudies-literature
Project description:BackgroundAn updated meta-analysis was performed to explore the clinical outcomes following the sutureless repair in patients with total anomalous pulmonary venous connection (TAPVC) and compare outcomes between the sutureless technique and conventional surgery.MethodsA systematic search of PubMed, Ovid-Embase, and Cochrane Library (CENTRAL) for relevant published studies that reported the clinical outcomes of the sutureless technique in children with TAPVC was performed in February 2022. The publication language was restricted to English.ResultsEleven studies were included involving 771 patients in total. Following the sutureless technique, the incidences of postoperative pulmonary venous obstruction (PVO) and reoperations due to PVO were 3.3% [95% confidence interval (CI), 1.3-5.3%] and 1.8% (95% CI, 0.3-3.3%), respectively. The early and late mortality rates were 3.2% (95% CI, 1.0-5.3%) and 2.5% (95% CI, 0.7-4.3%), respectively. Compared with conventional surgery, the sutureless technique significantly reduced the incidences of postoperative PVO [odds ratio (OR), 0.16; 95% CI, 0.08-0.33; P < 0.00001], reoperations due to PVO (OR, 0.25; 95% CI, 0.10-0.63; P = 0.003), and early mortality (OR, 0.40; 95% CI, 0.21-0.79; P = 0.008). However, no significant difference was found between conventional surgery and the sutureless technique concerning late mortality (OR, 0.63; 95% CI, 0.13-3.00; P = 0.58).ConclusionThe sutureless technique is superior to conventional surgery for the primary repair of TAPVC concerning postoperative PVO, reoperations due to PVO, and early mortality. However, the level of evidence is of low quality. Prospective cohort studies or randomized control trials (RCTs) should be performed to evaluate the effectiveness of sutureless techniques for primary TAPVC repair.
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