Postoperative Pulmonary Vein Stenosis (PVS) in Patients with TAPVR / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Despite recent advances in surgical technique and perioperative care of total anomalous pulmonary venous return (TAPVR), post-repair pulmonary vein stenosis (PVS) remains as a serious complication. We thought that the most important factors of TAPVR repair to prevent PVS were good exposure, proper alignment, and sufficient stoma size. We analyzed our experience retrospectively. MATERIAL AND METHOD: Between Jan. 1995 and Feb. 2005, we studied 74 patients diagnosed with TAPVR suitable for biventricular repair. Supra-cardiac type (n=41, 55.4%) was the most common. Mean CPB time, ACC time, and TCA (40.5%, 30/74) time were 92.1+/-25.9 min, 39.1+/-10.6 min, and 30.2+/-10.7 min, respectively. Mean follow-up duration was 41.4+/-29.1 months and follow-up was possible in all patients. RESULT: The median age and body weight at operation were 28.5 days (0~478 days) and 3.4 kg (1.4~9 kg). Early mortality was 4.1% (3/74). Causes of death were pulmonary hypertensive crisis, sepsis, and sudden death. There was PR-PVS in 2 patients (early 1, late 1). Both patients were cardiac type TAPVR drained to coronary sinus. Re-operations were done but only one patient survived. Cumulative survival rate in 5 year and percent freedom from PVS were 94.5+/-2.7% and 97.2+/-2.0%, respectively. CONCLUSION: There was no PVS in patients who underwent extra-cardiac anatomosis between LA and CPVC. Therefore it could be said that our principle might be effective in preventing PR-PVS in patients suitable two-ventricle.