Direct Anastomosis of Persistent Left Superior Vena Cava to Right Superior Vena Cava in a Pediatric Patient with Tetralogy of Fallot: an Alternative Technique (original) (raw)
Related papers
The Cavoatrial Anastomosis Procedure in Anomalous Connection of Superior Vena Cava to Left Atrium
World Journal for Pediatric and Congenital Heart Surgery, 2019
Anomalous connection of the superior vena cava to the morphologic left atrium is a rare congenital systemic venous abnormality. As opposed to pulmonary venous anomalies, the significant right-to-left shunt in these patients warrants a correction early in life. Optimal repair technique for combined pulmonary and systemic venous anomalies is not defined yet. Herein, we describe a neonate with such a diagnosis treated with cavoatrial anastomosis, known as Warden procedure with excellent results.
Anatomical repair of a persistent left superior vena cava into the left atrium
Interactive cardiovascular and thoracic surgery, 2010
The anatomy of a persistent left superior vena cava (SVC) to the left atrium (LA) without the innominate vein can make it challenging to complete intracardiac repair. We reviewed our five cases of the direct end-to-side anastomosis of SVCs to facilitate anatomical repair of SVC-right atrial connection for biventricular repair. Diagnoses were two partial atrioventricular septal defect with left isomerism, one complete atrioventricular septal defect (CAVSD) with left isomerism, one CAVSD without isomerism and one atrioventricular discordance and double outlet right ventricle with right isomerism. Mean age at the operation was 20+/-23 months (4-58 months) and body weight was 7.8+/-3.4 kg (4.8-12.7 kg). After completion of intracardiac repair, the SVC to LA was divided and end-to-side anastomosed to the SVC to the right atrium during cardiopulmonary bypass. No early or late death occurred during follow-up of 14.4+/-6.9 months (7-23 months). None of the patients developed an obstruction ...
Hemodynamic evaluation of 221 patients after intracardiac repair of tetralogy of Fallot
The American Journal of Cardiology, 1974
Cardiac catheterization and angiocardiographic studies were performed in 221 patients an average of 2 years (range 2 weeks to 10 years) after intracardiac repair of tetralogy of Fallot. The group represented 32.5 percent of the postoperative survivors. The postoperative result was classified as "excellent" (43 percent), "good" (35 percent), "satisfactory" (7 percent) or "unsatisfactory" (14 percent) on the basis of right ventricular peak systolic pressure, right ventricle to pulmonary artery peak systolic gradient and presence of a persistent large or small left to right shunt at the ventricular level. Unsatisfactory results were associated with obstructive pulmonary vascular disease (four patients), severe malformations with obstruction of the right ventricular outflow tract and/or a left to right shunt with a Qp:Qs ratio of greater than 1.51 or with currently uncorrectable obstructive anomalies of the right ventricular outflow tract or pulmonary arteries.
Development of a Double-Chambered Right Ventricle After Repair of Tetralogy of Fallot
Journal of the American College of Cardiology, 1998
Objectives. We sought to determine the frequency, etiology and progressive nature of midcavity obstruction in patients after primary repair of tetralogy of Fallot (TOF). Background. Midcavity obstruction (double-chambered right ventricle [DCRV]) represents a significant portion of reoperations in patients who have had TOF repair. This group is still poorly defined. Methods. A retrospective review of clinical, echocardiographic and catheterization data for all patients with TOF who later underwent reoperation for DCRV was performed. Results. Between 1973 and 1995, 552 children <2 years of age underwent primary TOF repair (median age 6.7 months). Longterm follow-up (median 50 months) was available in 308 children. Of these, 17 children subsequently developed DCRV requiring reoperation. The median age at initial operation was 7.9 months. During a median follow-up interval of 43.2 months, murmur intensity increased in all patients, and the average subpulmonary gradient at catheterization increased from 24 ؎ 10 to 80 ؎ 27 mm Hg in seven children (p ؍ 0.002) and at Doppler echocardiography from 14 ؎ 16 to 89 ؎ 18 mm Hg in five children (p ؍ 0.002). Before reoperation, 6 of the 17 children were symptomatic. During the operation (median age 55.4 months), obstruction was relieved by incision of hypertrophied anomalous muscle bundles in all 17 patients, with prominent fibrosis noted in 8 patients. Excessive septal and parietal hypertrophy was noted in one child. No new transannular patches were required. Recurrent obstruction has reappeared in 3 of these 17 children during follow-up. Conclusions. DCRV is a medium-term complication of TOF repair in infants, with a minimal incidence of 3.1% (95% CI 1.8% to 4.9%). The condition is progressive and is due to anomalous muscle bundle hypertrophy or fibrosis, or both, which may represent displaced insertion of a moderator band. Further reobstruction does occur; continued careful follow-up is therefore essential.
Medical Archives, 2018
Aim: The aim of this paper was to present a 65 year old female patient with chronic heart disease, surgically treated for congenital heart defect type Tetralogy of Fallot. Case report: In the sixth year of life the patient underwent palliative Potts anastomosis surgery which created an anastomosis between the left pulmonary artery and the descending aorta. Total correction was made in 34 years of life, six months after catheterization, which indicated malignant pulmonary hypertension. She is regularly followed up by the cardiologists and receives daily therapy. The present state of the patient is satisfactory with cardiomegaly, light left ventricular dysfunction, moderate mitral and tricuspid regurgitation, pulmonary arterial hypertension, and aneurysmatic dilatation of left pulmonary artery as well as atrial fibrillation. Conclusion: The intense development of cardiology and cardiac surgery in the USA in children and adults over the last fifty years has led to the extension and improvement of the quality of life.
Intermediate results after complete repair of tetralogy of Fallot in neonates☆, ☆☆, ★, ★★
The Journal of Thoracic and Cardiovascular Surgery, 1995
Intermediate results tetralogy of Fallot in after complete neonates repair of From July 1988 through September 1993, 30 neonates with symptomatic tetralogy of Fallot underwent complete repair. Sixteen patients had tetralogy and pulmonary stenosis, 9 had pulmonary atresia, 3 had nonconfluent pulmonary arteries, and 2 had both pulmonary atresia and nonconfluent pulmonary arteries. The median age at operation was 11 days (mean ± standard error of the mean, 12.6 ± 2.9 days), with a mean weight of 3.1 _ 0.1 kg (range 1.5 to 4.4 kg). Preoperatively, 14 patients were receiving an infusion of prostaglandin, 13 were mechanically ventilated, and 6 required inotropic support. Right ventricular outflow tract obstruction was managed by a limited transannular patch in 25 patients, infundibular muscle division with limited resection in 15, and insertion of a right ventricle-pulmonary artery valved aortic homograft conduit in 5 patients. Follow-up was complete at a median interval of 24 months (range 1 to 62 months). There were no hospital deaths and two late deaths, for 1-month, 1-year, and 5-year actuarial survivals of 100%, 93%, and 93%, respectively. The hazard function for death had a rapidly declining single phase that approached zero by 6 months after the operation. Both late deaths occurred in patients with tetralogy of Fallot and pulmonary atresia who had undergone aortic homograft conduit reconstruction, so that the only independent risk factor for death was the use of a valved homograft conduit (p-< 0.005). Eight patients required reoperation, resulting in 1.month, 1-year, and 5-year freedom from reoperation rates of 100%, 93%, and 66%, respectively. Indications for reoperation were branch left pulmonary artery stenosis in 5 patients, residual right ventricular outflow tract obstruction in 2 patients, and severe pulmonary insufficiency in 1 patient. Independent risk factors for reoperation included an intraoperative pressure ratio between the right and left ventricles of 0.75 or greater (p = 0.01), Doppler residual left pulmonary artery stenosis of 15 mm Hg or more, or Doppler right ventricular outflow tract obstruction gradient of 40 mm Hg or more at hospital discharge (p = 0.002 and 0.02, respectively). This series demonstrates the safety of early hemodynamic repair of symptomatic tetralogy of Fallot in neonates. It also emphasizes the importance of relieving all sources of right ventricular outflow tract obstruction at the initial operation, particularly that located at the site of insertion of the ductus arteriosus, which may be difficult to diagnose in the neonate before ductal closure occurs. The safety and efficacy of valved aortic homograft conduits in neonates requires further investigation. (J THORAC CARDIOVASC SURG 1995;109:332-44) Hani A. Hennein, MD a (by invitation), Ralph S. Mosca, MD a (by invitation), Gonzalo Urcelay, MD b (by invitation), Dennis C. Crowley, MD b (by invitation),
Cardiology Research and Cardiovascular Medicine, 2017
Background: Tetralogy of Fallot (TOF) is one of the common cyanotic heart diseases. Now total repair is spreading to save children at younger age and lower body weight. The aim of this study was to evaluate the results of the two different surgical techniques used for total repair of tetralogy of Fallot: transatrial-transpulmonary approach and transventricular approach with special emphasis on preoperative and intraoperative risk factors that affecting the prognosis of patients, and with analysis of postoperative short-term results. Patients and Methods: Between January 2014 and December 2016, sixty patients with TOF were randomly collected in a prospective study. Children divided into two groups, Group A included 30 patients repaired through transatrial-transpulmonary approach. Group B included 30 patients repaired through transventricular approach. Results: Preoperative characteristics and variables of patients were similar. As regard to cardiopulmonary bypass time, crossclamp time there were no significant differences(p>0.05). There were significant differences in ventilation time (p 0.023), inotropic support (p 0.001) and duration of stay in the ICU (p0.001). The incidence of arrhythmia 2 patients (6.7%) vs.5 patients (16.7%)] with non-significant difference. There is significant difference in right/left ventricular pressure ratio (p<0.05). At follow up, Comparisons between both groups showed no significant differences as regard to RV pressure and PG across the RVOT (P>0.05). None of our children needed reintervention for residual VSD or significant RVOTO. There were three mortalities (5%), one in group A due to RV dysfunction and two in group B due to ventricular arrhythmia and RV dysfunction. Conclusion: Total repair is the primary choice for management of FallotTetralogy.We encourage transatrial-transpulmonary repair to avoid ventricular incisions, otherwise a limited ventriculotomy is sufficient rather than extended ventriculotomy with transannular repair.