Left Atrial Mechanics in Isolated Total Anomalous Pulmonary Venous Connection after Repair

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Repaired total anomalous pulmonary venous connection (TAPVC) patients with preoperative pulmonary venous obstruction (PVO) show reduced left atrial (LA) reservoir function and pulmonary venous variability index (PVVI).
• This study investigated if reduced preoperative LA strain mechanics in isolated TAPVC patients predict postoperative PVO.

Purpose of the Study:

• To evaluate echocardiographic metrics and clinical characteristics associated with preoperative and postoperative PVO in isolated TAPVC patients.
• To compare these metrics to healthy controls.

Main Methods:

• Retrospective analysis of 64 isolated TAPVC patients undergoing repair with available echocardiograms (preoperative, immediate postoperative, follow-up).
• Comparison with 25 age and body surface area-matched healthy controls.
• LA strain analysis using TOMTEC software; PVO defined as peak Doppler velocity ≥1.2 m/sec.

Main Results:

• Preoperative PVO (≥1.2 m/sec) was associated with increased reintervention risk (P=.02).
• No preoperative LA strain metrics or PVVI predicted postoperative PVO or reintervention.
• TAPVC patients exhibited diminished pulmonary vein Doppler velocities, left ventricle length, and LA mechanics compared to controls, though LA and LV volumes normalized over time.

Conclusions:

• Preoperative pulmonary vein Doppler velocity ≥1.2 m/sec is a risk factor for reintervention in repaired isolated TAPVC.
• No preoperative LA mechanics or other echocardiographic metrics predict postoperative PVO or reintervention.
• Pulmonary vein hypoplasia/stenosis, not immediate postoperative LA volumes, drives reintervention risk.