Safety and mid- to long-term efficacy analysis of surgical correction of isolated partial anomalous pulmonary venous connection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MU Chunjie ¹ ,  MA Runwei ¹ , YAN Jun ² , OUYANG Wenbin ² , YANG Juxian ³ , LU Fawen ³

1. Department of Cardiac Surgery, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650102, P. R. China;
2. Department of Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
3. Pediatric Intensive Care Unit, Fuwai Yunnan Cardiovascular Hospital, Kunming, 650102, P. R. China;

Corresponding author：

MA Runwei, Email: marw0102@aliyun.com

Keywords：

Isolated partial anomalous pulmonary venous connection; cardiac surgical treatment; curative effect analysis; safety; congenital heart disease

DOI：

10.7507/1007-4848.202206019

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Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.

Citation： MU Chunjie, MA Runwei, YAN Jun, OUYANG Wenbin, YANG Juxian, LU Fawen. Safety and mid- to long-term efficacy analysis of surgical correction of isolated partial anomalous pulmonary venous connection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(3): 413-420. doi: 10.7507/1007-4848.202206019 Copy

1.	Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. First of two parts. N Engl J Med, 2000, 342(4): 256-263.
2.	Kumar T, Patra S, Ramalingam R, et al. Pulmonary hypertension due to presence of isolated partial anomalous pulmonary venous connection: A case report. J Cardiovasc Dis Res, 2013, 4(4): 239-241.
3.	Abman SH, Hansmann G, Archer SL, et al. Pediatric pulmonary hypertension: Guidelines from the American Heart Association and American Thoracic Society. Circulation, 2015, 132(21): 2037-2099.
4.	Brody H. Drainage of the pulmonary veins into the right side of the heart. Arch Pathol, 1942, 33: 221-240.
5.	Suzuki K, Iwata Y, Hiramatsu T, et al. Mid- to long-term surgical outcomes of partial anomalous pulmonary venous connection. Gen Thorac Cardiovasc Surg, 2021, 69(1): 27-31.
6.	Haramati LB, Moche IE, Rivera VT, et al. Computed tomography of partial anomalous pulmonary venous connection in adults. J Comput Assist Tomogr, 2003, 27(5): 743-749.
7.	Ellis A, Webb G. Partial Anomalous Pulmonary Venous Connections. 3rd ed. Missouri: Mosby Inc. 2009.
8.	Ammannaya GKK, Mishra P, Khandekar JV. Left sided PAPVC with intact IAS-surgically managed with vertical vein anastomosis to LA appendage: A rare case report. Int J Surg Case Rep, 2019, 59: 217-219.
9.	Ammash NM, Seward JB, Warnes CA, et al. Partial anomalous pulmonary venous connection: Diagnosis by transesophageal echocardiography. J Am Coll Cardiol, 1997, 29(6): 1351-1358.
10.	Bonelli-Sica JM, de la Mora-Cervantes R, Diaz-Zamudio M, et al. Dual-source 256-MDCT for diagnosis of anomalous pulmonary venous drainage in pediatric population. AJR Am J Roentgenol, 2013, 200(2): W163-W169.
11.	Hegde M, Manjunath SC, Usha MK. Isolated partial anomalous pulmonary venous connection: Development of volume overload and elevated estimated pulmonary pressure in adults. J Clin Imaging Sci, 2019, 9: 29.
12.	Majdalany DS, Phillips SD, Dearani JA, et al. Isolated partial anomalous pulmonary venous connections in adults: Twenty-year experience. Congenit Heart Dis, 2010, 5(6): 537-545.
13.	Al-Ahmari S, Chandrasekaran K, Brilakas E, et al. Isolated partial anomalous pulmonary venous connection: Diagnostic value of suprasternal color flow imaging and contrast echocardiography. J Am Soc Echocardiogr, 2003, 16(8): 884-889.
14.	de Roos A, Roest AA. Evaluation of congenital heart disease by magnetic resonance imaging. Eur Radiol, 2000, 10(1): 2-6.
15.	Halasz NA, Halloran KH, Liebow AA. Bronchial and arterial anomalies with drainage of the right lung into the inferior vena cava. Circulation, 1956, 14(5): 826-846.
16.	Trusler G A, Kazenelson G, Freedom R M, et al. Late results following repair of partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. J Thorac Cardiovasc Surg, 1980, 79: 776-781.
17.	Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.

1. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. First of two parts. N Engl J Med, 2000, 342(4): 256-263.
2. Kumar T, Patra S, Ramalingam R, et al. Pulmonary hypertension due to presence of isolated partial anomalous pulmonary venous connection: A case report. J Cardiovasc Dis Res, 2013, 4(4): 239-241.
3. Abman SH, Hansmann G, Archer SL, et al. Pediatric pulmonary hypertension: Guidelines from the American Heart Association and American Thoracic Society. Circulation, 2015, 132(21): 2037-2099.
4. Brody H. Drainage of the pulmonary veins into the right side of the heart. Arch Pathol, 1942, 33: 221-240.
5. Suzuki K, Iwata Y, Hiramatsu T, et al. Mid- to long-term surgical outcomes of partial anomalous pulmonary venous connection. Gen Thorac Cardiovasc Surg, 2021, 69(1): 27-31.
6. Haramati LB, Moche IE, Rivera VT, et al. Computed tomography of partial anomalous pulmonary venous connection in adults. J Comput Assist Tomogr, 2003, 27(5): 743-749.
7. Ellis A, Webb G. Partial Anomalous Pulmonary Venous Connections. 3rd ed. Missouri: Mosby Inc. 2009.
8. Ammannaya GKK, Mishra P, Khandekar JV. Left sided PAPVC with intact IAS-surgically managed with vertical vein anastomosis to LA appendage: A rare case report. Int J Surg Case Rep, 2019, 59: 217-219.
9. Ammash NM, Seward JB, Warnes CA, et al. Partial anomalous pulmonary venous connection: Diagnosis by transesophageal echocardiography. J Am Coll Cardiol, 1997, 29(6): 1351-1358.
10. Bonelli-Sica JM, de la Mora-Cervantes R, Diaz-Zamudio M, et al. Dual-source 256-MDCT for diagnosis of anomalous pulmonary venous drainage in pediatric population. AJR Am J Roentgenol, 2013, 200(2): W163-W169.
11. Hegde M, Manjunath SC, Usha MK. Isolated partial anomalous pulmonary venous connection: Development of volume overload and elevated estimated pulmonary pressure in adults. J Clin Imaging Sci, 2019, 9: 29.
12. Majdalany DS, Phillips SD, Dearani JA, et al. Isolated partial anomalous pulmonary venous connections in adults: Twenty-year experience. Congenit Heart Dis, 2010, 5(6): 537-545.
13. Al-Ahmari S, Chandrasekaran K, Brilakas E, et al. Isolated partial anomalous pulmonary venous connection: Diagnostic value of suprasternal color flow imaging and contrast echocardiography. J Am Soc Echocardiogr, 2003, 16(8): 884-889.
14. de Roos A, Roest AA. Evaluation of congenital heart disease by magnetic resonance imaging. Eur Radiol, 2000, 10(1): 2-6.
15. Halasz NA, Halloran KH, Liebow AA. Bronchial and arterial anomalies with drainage of the right lung into the inferior vena cava. Circulation, 1956, 14(5): 826-846.
16. Trusler G A, Kazenelson G, Freedom R M, et al. Late results following repair of partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. J Thorac Cardiovasc Surg, 1980, 79: 776-781.
17. Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Safety and mid- to long-term efficacy analysis of surgical correction of isolated partial anomalous pulmonary venous connection

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