[Correction of total anomalous pulmonary venous connection in infant less than one year old]
Jun Yan1, Qingliang Chen, Yinglong Liu
1Department of Surgery, Institute of Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Early surgical correction for total anomalous pulmonary venous connection (TAPVC) in infants under one year old shows satisfactory early results. Long-term outcomes require further observation, with surgical technique being crucial for specific TAPVC types.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Medical Research
Context:
- Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart defect.
- Infants diagnosed with TAPVC require timely surgical intervention for survival.
- Surgical outcomes can vary based on the type and complexity of TAPVC.
Purpose:
- To evaluate the early efficacy of surgical correction for TAPVC in infants.
- To identify factors influencing operative success and complications.
- To assess the impact of surgical approach on patient outcomes.
Summary:
- This study analyzed 28 infants under one year old undergoing surgical correction for TAPVC.
- Overall mortality within 30 days was 12.5%, with specific causes including circulatory failure and bleeding.
- Arrhythmia was the most common complication (41.67%), with variations depending on TAPVC type and surgical approach.
Impact:
- Early surgical correction for TAPVC in infants yields promising short-term results.
- Surgical technique, particularly wide anastomosis, is critical for favorable outcomes in supracardic TAPVC.
- Further research is needed to ascertain the long-term effects of early correction and optimize surgical strategies.
Objective:
To evaluate the effects of early correction for total anomalous pulmonary venous connection (TAPVC) in infant under one.
Methods:
Twenty-eight infants less than one year old with TAPVC were admitted and prepared to be treated surgically from July 1995 to August 2001. Total correction was performed on 24 cases, 20 males and 4 females, aged 6.04 +/- 3.34 months, with the mean body weight of 5.74 +/- 1.22 kg, of which 10 (41.67%) being of supracardic type, 11 (45.83%) being of intracardiac type, 1 (4.17%) being of infracardiac type, and 2 (8.33%) being of mixed type. Four patients died of hypoxic attack during anteoperative preparation and failed to be operated upon.
Results:
Three infants (12.5%) died within 30 days after operation. One case of intracardiac type died of circulatory failure because of severe postoperative bleeding and late exploratory thoracotomy. One case of supracardiac type died of cardiac sufficiency because of bleeding at anastomotic stoma during operation. One case of mixed type died of circulatory failure because of high pressure of left cardiac atrium. All of the 4 cases who underwent emergent operation survived. The most common complication was arrhythmia (41.67%).
Conclusion:
The early effect of early correction for TAPVC is satisfactory and its long-term effect is to be observed. A wide anastomosis between the posterior wall of the left atrium and common pulmonary vein is more important for the supracardic type. The diameters of left atrium, left ventricle and atrial septum defect have little effect on operative results. Arrhythmia after operation has no significant increase in supracardic type through. With rather high incidence rate of arrhythmia (5/8, 62.5%), the combined left atrium incision and right atrium incision approach assures a sufficiently large incision for the supracardiac type. However, this approach is statistically different in the incidence rate of arrhythmia only between supracardiac type and intracardiac type.
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