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Liu X, Liufu R, Liu T, Cen J, Yu J, Wen S, Ou Y, Chen J, Zhuang J. Supracardiac total anomalous pulmonary venous connection type Ib: Morphology and outcomes. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01066-2. [PMID: 36732145 DOI: 10.1016/j.jtcvs.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Supracardiac total anomalous pulmonary venous connection is the most common subtype of total anomalous pulmonary venous connection. We aimed to describe the morphological spectrum of supracardiac total anomalous pulmonary venous connection and to identify risk factors for death and postoperative pulmonary venous obstruction. METHODS From February 2009 to June 2019, 241 patients diagnosed with supracardiac-Ia (left-sided vertical vein, n = 185) or supracardiac-Ib (right-sided connection directly to superior vena cava, n = 56) total anomalous pulmonary venous connection underwent initial surgical repair at our institute. Cases with functionally univentricular circulations or atrial isomerism were excluded. Patients' postoperative survival was described by Kaplan-Meier curves. Cox proportional hazards models and competing risk regression models were used to identify clinical risk factors for death and postoperative pulmonary venous obstruction. RESULTS There were 8 early deaths and 4 late deaths. The overall survivals at 30 days, 1 year, and 10 years were 97.1%, 94.8%, and 94.8%, respectively, in the supracardiac-Ia group (2.7%, 5/185) (hazard ratio, 4.8; P = .003). Five patients required reoperation for pulmonary venous obstruction, including 2 patients who required reintervention for superior vena cava syndromes (all in the supracardiac-Ib group). One patient required superior vena cava balloon dilation for superior vena cava syndromes. Multivariable analysis showed that the supracardiac-Ib group (12.5%, 7/56) had a significantly higher mortality rate than the supracardiac-Ia group (adjusted hazard ratio, 8.5, P = .008). Surgical weight less than 2.5 kg (adjusted hazard ratio, 10.8, P = .023), longer duration of cardiopulmonary bypass (adjusted hazard ratio, 1.15 per 10 minutes, P = .012), and supracardiac-Ib subtype (adjusted hazard ratio, 4.7, P = .037) were independent risk factors associated with death. The supracardiac-Ib subtype (adjusted hazard ratio, 4.8, P = .003) was an incremental risk factor associated with postoperative pulmonary venous obstruction. CONCLUSIONS Morphological features of supracardiac total anomalous pulmonary venous connection, especially the supracardiac-Ib subtype, were risk factors associated with postoperative pulmonary venous obstruction and survival. Patients with unique anatomic subtypes might require more individualized surgical planning.
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Affiliation(s)
- Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rong Liufu
- Department of Cardiovascular Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juemin Yu
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanqiu Ou
- Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Guangzhou, China.
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2
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Rizzi S, Ströker E, El Housari M, Belsack D, Chierchia GB, de Asmundis C. Cryoballoon ablation of atrial fibrillation in a patient with partial anomalous pulmonary vein drainage in the superior vena cava. HeartRhythm Case Rep 2022; 8:119-121. [PMID: 35242551 PMCID: PMC8858733 DOI: 10.1016/j.hrcr.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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3
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Frank DB, Levy PT, Stiver CA, Boe BA, Baird CW, Callahan RM, Smith CV, Vanderlaan RD, Backes CH. Primary pulmonary vein stenosis during infancy: state of the art review. J Perinatol 2021; 41:1528-1539. [PMID: 33674714 DOI: 10.1038/s41372-021-01008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Primary pulmonary vein stenosis (PPVS) is an emerging problem among infants. In contrast to acquired disease, PPVS is the development of stenosis in the absence of preceding intervention. While optimal care approaches remain poorly characterized, over the past decade, understanding of potential pathophysiological mechanisms and development of novel therapeutic strategies are increasing. A multidisciplinary team of health care providers was assembled to review the available evidence and provide a common framework for the diagnosis, management, and treatment of PPVS during infancy. To address knowledge gaps, institutional and multi-institutional approaches must be employed to generate knowledge specific to ex-premature infants with PPVS. Within individual institutions, creation of a team comprised of dedicated health care providers from diverse backgrounds is critical to accelerate clinical learning and provide care for infants with PPVS. Multi-institutional collaborations, such as the PVS Network, provide the infrastructure and statistical power to advance knowledge for this rare disease.
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Affiliation(s)
- David B Frank
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Corey A Stiver
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christopher W Baird
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ryan M Callahan
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Charles V Smith
- Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel D Vanderlaan
- Department of Thoracic Surgery, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Carl H Backes
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. .,Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
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4
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Rivaud MR, Blok M, Jongbloed MRM, Boukens BJ. How Cardiac Embryology Translates into Clinical Arrhythmias. J Cardiovasc Dev Dis 2021; 8:jcdd8060070. [PMID: 34199178 PMCID: PMC8231901 DOI: 10.3390/jcdd8060070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022] Open
Abstract
The electrophysiological signatures of the myocardium in cardiac structures, such as the atrioventricular node, pulmonary veins or the right ventricular outflow tract, are established during development by the spatial and temporal expression of transcription factors that guide expression of specific ion channels. Genome-wide association studies have shown that small variations in genetic regions are key to the expression of these transcription factors and thereby modulate the electrical function of the heart. Moreover, mutations in these factors are found in arrhythmogenic pathologies such as congenital atrioventricular block, as well as in specific forms of atrial fibrillation and ventricular tachycardia. In this review, we discuss the developmental origin of distinct electrophysiological structures in the heart and their involvement in cardiac arrhythmias.
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Affiliation(s)
- Mathilde R. Rivaud
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands;
| | - Michiel Blok
- Department of Anatomy & Embryology, Leiden University Medical Center, Einthovenweg 20, 2300 RC Leiden, The Netherlands; (M.B.); (M.R.M.J.)
| | - Monique R. M. Jongbloed
- Department of Anatomy & Embryology, Leiden University Medical Center, Einthovenweg 20, 2300 RC Leiden, The Netherlands; (M.B.); (M.R.M.J.)
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Bastiaan J. Boukens
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands;
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-(0)20-566-4659
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5
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Faber JW, Hagoort J, Moorman AFM, Christoffels VM, Jensen B. Quantified growth of the human embryonic heart. Biol Open 2021; 10:bio.057059. [PMID: 33495211 PMCID: PMC7888713 DOI: 10.1242/bio.057059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The size and growth patterns of the components of the human embryonic heart have remained largely undefined. To provide these data, three-dimensional heart models were generated from immunohistochemically stained sections of ten human embryonic hearts ranging from Carnegie stage 10 to 23. Fifty-eight key structures were annotated and volumetrically assessed. Sizes of the septal foramina and atrioventricular canal opening were also measured. The heart grows exponentially throughout embryonic development. There was consistently less left than right atrial myocardium, and less right than left ventricular myocardium. We observed a later onset of trabeculation in the left atrium compared to the right. Morphometry showed that the rightward expansion of the atrioventricular canal starts in week 5. The septal foramina are less than 0.1 mm2 and are, therefore, much smaller than postnatal septal defects. This chronological, graphical atlas of the growth patterns of cardiac components in the human embryo provides quantified references for normal heart development. Thereby, this atlas may support early detection of cardiac malformations in the foetus.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Jaeike W Faber
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Jaco Hagoort
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Antoon F M Moorman
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands
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6
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Morozov AA, Movsesyan RR, Latypov AK, Martynova OA, Vasichkina ES. Peculiarities of Histological Structure of Pulmonary Veins in Patients with Total Anomalous Pulmonary Venous Drainage as Morphological Substrates Relating to Formation of Postoperative Pulmonary Venous Obstruction. Bull Exp Biol Med 2020; 168:699-703. [PMID: 32248453 DOI: 10.1007/s10517-020-04783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 10/24/2022]
Abstract
The histological and immunohistochemical methods were employed to examine the peculiarities of histological structure of pulmonary veins and left atrium of the heart in norm and in various types of total anomalous drainage of pulmonary veins. In contrast to normal pulmonary vein covered with external multiple muscle layers (myocardial sleeve), such sleeve is absent in veins that have no connection with the left atrium irrespective of the type of the defect. In patients with total anomalous pulmonary venous drainage, the structure of left atrium was heterogeneous featuring either the presence or absence of inner angiomural lining in this atrium. The structural peculiarities are important for insight into etiology of the development of postoperative pulmonary venous obstruction in patients with total anomalous pulmonary venous drainage.
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Affiliation(s)
- A A Morozov
- V. A. Almazov National Medical Research Center, St. Petersburg, Russia
| | - R R Movsesyan
- The First Municipal Children Hospital, St. Petersburg, Russia.
| | - A K Latypov
- V. A. Almazov National Medical Research Center, St. Petersburg, Russia
| | - O A Martynova
- V. A. Almazov National Medical Research Center, St. Petersburg, Russia
| | - E S Vasichkina
- V. A. Almazov National Medical Research Center, St. Petersburg, Russia
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7
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Masaki N, Adachi O, Katahira S, Saiki Y, Horii A, Kawamoto S, Saiki Y. Progression of vascular remodeling in pulmonary vein obstruction. J Thorac Cardiovasc Surg 2020; 160:777-790.e5. [PMID: 32222412 DOI: 10.1016/j.jtcvs.2020.01.098] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Pulmonary vein obstruction (PVO) frequently occurs after repair of total anomalous pulmonary vein connection with progression of intimal hyperplasia from the anastomotic site toward upstream pulmonary veins (PVs). However, the understanding of mechanism in PVO progression is constrained by lack of data derived from a physiological model of the disease, and no prophylaxis has been established. We developed a new PVO animal model, investigated the mechanisms of PVO progression, and examined a new prophylactic strategy. METHODS We developed a chronic PVO model using infant domestic pigs by cutting and resuturing the left lower PV followed by weekly hemodynamic parameter measurement and angiographic assessment of the anastomosed PV. Subsequently, we tested a novel therapeutic strategy with external application of rapamycin-eluting film to the anastomotic site. RESULTS We found the pig PVO model mimicked human PVO hemodynamically and histopathologically. This model exhibited increased expression levels of Ki-67 and phospho-mammalian target of rapamycin in smooth muscle-like cells at the anastomotic neointima. In addition, contractile to synthetic phenotypic transition; that is, dedifferentiation of smooth muscle cells and mammalian target of rapamycin pathway activation in the neointima of upstream PVs were observed. Rapamycin-eluting films externally applied around the anastomotic site inhibited the activation of mammalian target of rapamycin in the smooth muscle-like cells of neointima, and delayed PV anastomotic stenosis. CONCLUSIONS We demonstrate the evidence on dedifferentiation of smooth muscle-like cells and mammalian target of rapamycin pathway activation in the pathogenesis of PVO progression. Delivery of rapamycin to the anastomotic site from the external side delayed PV anastomotic stenosis, implicating a new therapeutic strategy to prevent PVO progression.
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Affiliation(s)
- Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Shintaro Katahira
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Akira Horii
- Department of Molecular Pathology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan.
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8
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Shi X, Lu Y, Sun K. Research Progress in Pathogenesis of Total Anomalous Pulmonary Venous Connection. Methods Mol Biol 2020; 2204:173-178. [PMID: 32710324 DOI: 10.1007/978-1-0716-0904-0_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Congenital heart defect (CHD) is one of the most common birth defects and the leading course of infant mortality. Total anomalous pulmonary venous connection (TAPVC) is a rare type of cyanotic which accounting for approximately 1-3% of congenital heart disease cases. Based on where the anomalous veins drain, TAPVC can be divided into four subtypes: supracardiac, cardiac, infracardiac, and mixed. In TAPVC, all pulmonary veins fail to link to the left atrium correctly but make abnormal connections to the right atrium or systemic venous system. The mortality of TAPVC patients without proper intervention is nearly 80% in the first year of life and 50% of them died within 3 months after birth. However, the pathogenesis and mechanism of TAPVC remains elusive. In this chapter, we systematically review the epidemiology, anatomy, and pathophysiology of TAPVC and give an overview of the research progress of TAPVC pathogenesis.
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Affiliation(s)
- Xin Shi
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Lu
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Kun Sun
- Department of Pediatric Cardiology, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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9
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Surgical ductal stent implantation in total anomalous pulmonary venous connection to vena porta with right pulmonary sequestration in a mature newborn. Ann Med Surg (Lond) 2019; 45:33-35. [PMID: 31360457 PMCID: PMC6639658 DOI: 10.1016/j.amsu.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
In many cases of total anomalous pulmonary venous connection (TAPVC), the four pulmonary veins (PV) join together behind the left atrium, where they form a collector. This collector can drain into the right atrium directly through the innominate vein into the superior vena cava (SVC), into the coronary sinus (CS), or through the diaphragm to the venous structures of the abdomen. In our case, a mature newborn had TAPVC draining into the vena porta along with severe pulmonary hypertension. Additionally, there were right pulmonary sequestration, dextrocardia, transposition of the great arteries, severe pulmonary stenosis, and single ventricular pathology in echocardiographic examination. Clinical signs manifested in the first 7 days of life. Diagnostic tools used were echocardiography and angiography. A ductal stent was surgically implanted into the ductus arteriosus by angiography. TAPVC was found to be nonobstructive. Therefore, we would like to emphasize the rareness and hardness to perform the surgical ductal implant technique in our particular case of TAPVC with pulmonary sequestration draining into the vena porta. The prognosis in TAPVC is poor and related mainly to the existence of pulmonary venous obstruction.
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Kai L, Xiaoyang Z, Jinghao Z, Zhongqun Z, Qi S, Xiaomin H, Zhiwei X, Jinfen L. Outcomes of Reinterventions for Children with Postoperative Pulmonary Venous Restenosis. Pediatr Cardiol 2019; 40:965-972. [PMID: 30937500 DOI: 10.1007/s00246-019-02098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
This report aims to summarize and evaluate the efficacy and experience of reintervention for children with postoperative pulmonary venous restenosis. Clinical data from 61 patients with postoperative pulmonary venous restenosis who underwent reintervention at Shanghai Children's Medical Center (SCMC) from September 2009 to June 2018 were retrospectively analyzed. The patients comprised 38 boys and 23 girls, with a mean age of 15.4 ± 12.6 months (2-83 months) and a mean weight of 8.1 ± 3.4 kg (3.7-18.5 kg). The mean pulmonary venous velocity was 2.31 ± 0.47 m/s (1.86-3.22 m/s). Primary disease included 48 cases of total anomalous pulmonary venous drainage, nine cases of partial anomalous pulmonary venous drainage, and four cases of primary pulmonary venous stenosis. The reintervention procedures included 34 cases using the sutureless technique, ten cases using bovine pericardium enlargement, three cases using blunt enlargement, four cases of balloon dilatation, one case using stent implantation and nine cases involving more than two surgical methods. The early postoperative pulmonary venous velocity was 1.16 ± 0.20 m/s. There were five in-hospital deaths, resulting in a mortality rate of 8.2%. Fifty-six survivors were followed for 52.8 ± 46.5 months (6-103 months) with no delayed deaths. Echocardiography showed pulmonary venous anastomosis and diameter growth after reintervention, exhibiting a mean growth speed of 0.026 ± 0.013 cm/month (p < 0.05) and a mean velocity of 1.24 ± 0.26 m/s; five patients experienced varying degrees of pulmonary venous obstruction (> 1.6 m/s), but did not require reoperation. Postoperative pulmonary venous restenosis is a common complication after surgery for pulmonary venous malformations. Reintervention should be performed in the early period of pulmonary venous obstruction. Growth of pulmonary venous anastomoses was observed after performing the sutureless technique, bovine pericardium enlargement and blunt enlargement. Although balloon dilatation has a good effect in the early postoperative period, its restenosis rate is high, and strict mid- to long-term follow-up is needed.
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Affiliation(s)
- Luo Kai
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Zhang Xiaoyang
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Zheng Jinghao
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China.
| | - Zhu Zhongqun
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Sun Qi
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - He Xiaomin
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Xu Zhiwei
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
| | - Liu Jinfen
- Department of Cardiothoracic Surgery, School of Medicine, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, Dongfang Road 1678, Shanghai, China
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11
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Al Qbandi M, Thinakar Vel M. Transcatheter therapy of partial anomalous pulmonary venous connection with dual drainage and coarctation of the aorta in a single patient. J Saudi Heart Assoc 2018; 30:311-315. [PMID: 30072840 PMCID: PMC6068332 DOI: 10.1016/j.jsha.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/21/2018] [Accepted: 06/02/2018] [Indexed: 12/01/2022] Open
Abstract
A 12-year-old boy was found to have aortic coarctation and a partial anomalous pulmonary venous connection. Historically, multiple cardiac pathologies, such as in the present case, required a surgical approach. We describe transcatheter treatment of the coarctation with a stent and occlusion of the partial anomalous pulmonary venous connection with an Amplatzer vascular plug in a single patient without complications.
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Affiliation(s)
- Mustafa Al Qbandi
- Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, KuwaitaKuwait
- Corresponding author at: Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, P.O. Box 4081, Safat 13041, Kuwait.
| | - Mariappa Thinakar Vel
- Pediatric Cardiology Department, Chest Disease Hospital, Ministry of Health, KuwaitaKuwait
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12
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Liufu R, Shi G, Zhu F, Guan Y, Lu Z, Chen W, Zhu Z, Chen H. Superior Approach for Supracardiac Total Anomalous Pulmonary Venous Connection. Ann Thorac Surg 2018; 105:1429-1435. [DOI: 10.1016/j.athoracsur.2018.01.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/11/2018] [Accepted: 01/15/2017] [Indexed: 10/18/2022]
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Duplication and Deletion of 22q11 Associated with Anomalous Pulmonary Venous Connection. Pediatr Cardiol 2018; 39:585-590. [PMID: 29279955 DOI: 10.1007/s00246-017-1794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
Anomalous pulmonary venous connection (APVC) is an uncommon congenital anomaly in which pulmonary venous blood flows directly into the right side of the heart or into the systemic veins. To identify whether there is any association between 22q11 CNVs and APVC, we analyzed the clinical data of 86 APVC patients and then studied the CNVs of 22q11 in 86 sporadic APVC patients by multiplex ligation-dependent probe amplification. The results showed that two patients carried the CNVs of 22q11, one patient had the deletion of 22q11 and the other had the duplication of 22q11. The incidence was significantly higher than that in the normal population (P < 0.01) that suggests a possible etiologic association between the duplication or deletion of 22q11 and the APVC in our patients.
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14
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Chen H. Response by Chen to Letters Regarding Article, "Total Anomalous Pulmonary Venous Connection: The Current Management Strategies in a Pediatric Cohort of 768 Patients". Circulation 2017; 135:e1095-e1096. [PMID: 28559502 DOI: 10.1161/circulationaha.117.027926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Huiwen Chen
- From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China
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15
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Goyal R, Gracia E, Fan R. The Role of Superior Vena Cava Isolation in the Management of Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2674-2680. [PMID: 32494445 PMCID: PMC7252918 DOI: 10.19102/icrm.2017.080406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
The superior vena cava (SVC) has been identified as one of the most common sources of non-pulmonary vein triggers for atrial fibrillation (AF). SVC isolation has been shown to improve long-term maintenance of normal sinus rhythm in patients with paroxysmal AF. However, ablation at the SVC is associated with risks of phrenic nerve injury, sinus node dysfunction, and SVC stenosis. The use of electroanatomical mapping, intracardiac echocardiography, compound motor action potentials, and segmental (rather than circumferential) ablation are all strategies to reduce complications. Given these risks, SVC isolation is most effective as an adjunct to pulmonary vein isolation for patients with paroxysmal AF who have been found to have an arrhythmogenic SVC.
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Affiliation(s)
- Rajat Goyal
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, NY
| | - Ely Gracia
- Department of Internal Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Roger Fan
- Heart Rhythm Center, Stony Brook University Hospital, Stony Brook, NY
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Yoshimura N, Fukahara K, Yamashita A, Doi T, Takeuchi K, Yamashita S, Homma T, Yokoyama S, Aoki M, Ikeno Y. Surgery for total anomalous pulmonary venous connection: primary sutureless repair vs. conventional repair. Gen Thorac Cardiovasc Surg 2017; 65:245-251. [DOI: 10.1007/s11748-017-0769-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
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Lim WK, Leong MC, Samion H. Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage. Ann Pediatr Cardiol 2016; 9:183-5. [PMID: 27212859 PMCID: PMC4867809 DOI: 10.4103/0974-2069.173549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage.
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Affiliation(s)
- W K Lim
- Pediatric and Congenital Heart Center (PCHC), National Heart Institute, Kuala Lumpur, Malaysia
| | - M C Leong
- Pediatric and Congenital Heart Center (PCHC), National Heart Institute, Kuala Lumpur, Malaysia
| | - H Samion
- Pediatric and Congenital Heart Center (PCHC), National Heart Institute, Kuala Lumpur, Malaysia
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Kirubakaran S, Rajani R, Linton N, Kiesewetter C, Anderson D, O'Neill M. Catheter ablation for persistent atrial fibrillation in a patient with previous repair of total anomalous pulmonary venous connection. Circ Arrhythm Electrophysiol 2013; 6:e54-5. [PMID: 23962863 DOI: 10.1161/circep.113.000483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Senthil Kirubakaran
- Cardiothoracic Centre, Guy's and St. Thomas' NHS Trust, London, United Kingdom
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Yoshimura N, Fukahara K, Yamashita A, Doki Y, Doi T, Takeuchi K, Higuma T, Senda K, Toge M, Nagura S. Management of pulmonary venous obstruction. Gen Thorac Cardiovasc Surg 2012; 60:785-91. [DOI: 10.1007/s11748-012-0154-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Indexed: 11/28/2022]
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AGARWAL SHARADC, BITTINGER LOGAN, TANG ANTHONYS. Importance of Superior Vena Cava Isolation in Successful Ablation of Persistent Atrial Fibrillation in Patient with Partial Anomalous Pulmonary Vein. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:e146-9. [DOI: 10.1111/j.1540-8159.2012.03508.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 06/12/2012] [Accepted: 07/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- SHARAD C. AGARWAL
- Department of Cardiology; Royal Jubilee Hospital; Victoria; British Columbia; Canada
| | - LOGAN BITTINGER
- Department of Cardiology; Royal Jubilee Hospital; Victoria; British Columbia; Canada
| | - ANTHONY S. TANG
- Department of Cardiology; Royal Jubilee Hospital; Victoria; British Columbia; Canada
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El Guindi W, Dreyfus M, Carles G, Lambert V, Herlicoviez M, Benoit G. [Contribution of 3D-ultrasound in the heterotaxy syndromes: about four cases and review of the literature]. J Gynecol Obstet Hum Reprod 2012; 41:489-496. [PMID: 22704359 DOI: 10.1016/j.jgyn.2012.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 03/30/2012] [Accepted: 04/18/2012] [Indexed: 06/01/2023]
Abstract
The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.
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Affiliation(s)
- W El Guindi
- Service de gynécologie-obstétrique, centre hospitalier de l'Ouest Guyanais, 16 boulevard du Général-Leclerc, BP 245, Saint-Laurent-du-Maroni, Guyana.
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Normal and abnormal development of pulmonary veins: State of the art and correlation with clinical entities. Int J Cardiol 2011; 147:13-24. [DOI: 10.1016/j.ijcard.2010.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/17/2010] [Accepted: 07/04/2010] [Indexed: 11/19/2022]
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Bleyl SB, Saijoh Y, Bax NAM, Gittenberger-de Groot AC, Wisse LJ, Chapman SC, Hunter J, Shiratori H, Hamada H, Yamada S, Shiota K, Klewer SE, Leppert MF, Schoenwolf GC. Dysregulation of the PDGFRA gene causes inflow tract anomalies including TAPVR: integrating evidence from human genetics and model organisms. Hum Mol Genet 2010; 19:1286-301. [PMID: 20071345 DOI: 10.1093/hmg/ddq005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Total anomalous pulmonary venous return (TAPVR) is a congenital heart defect inherited via complex genetic and/or environmental factors. We report detailed mapping in extended TAPVR kindreds and mutation analysis in TAPVR patients that implicate the PDGFRA gene in the development of TAPVR. Gene expression studies in mouse and chick embryos for both the Pdgfra receptor and its ligand Pdgf-a show temporal and spatial patterns consistent with a role in pulmonary vein (PV) development. We used an in ovo function blocking assay in chick and a conditional knockout approach in mouse to knock down Pdgfra expression in the developing venous pole during the period of PV formation. We observed that loss of PDGFRA function in both organisms causes TAPVR with low penetrance (approximately 7%) reminiscent of that observed in our human TAPVR kindreds. Intermediate inflow tract anomalies occurred in a higher percentage of embryos (approximately 30%), suggesting that TAPVR occurs at one end of a spectrum of defects. We show that the anomalous pulmonary venous connection seen in chick and mouse is highly similar to TAPVR discovered in an abnormal early stage embryo from the Kyoto human embryo collection. Whereas the embryology of the normal venous pole and PV is becoming understood, little is known about the embryogenesis or molecular pathogenesis of TAPVR. These models of TAPVR provide important insight into the pathogenesis of PV defects. Taken together, these data from human genetics and animal models support a role for PDGF-signaling in normal PV development, and in the pathogenesis of TAPVR.
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Affiliation(s)
- Steven B Bleyl
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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