ABSTRACT
We present the case of an infant with total anomalous pulmonary venous connection and a branching vertical vein with multiple points of narrowing, draining the confluence into the innominate vein. The embryology and clinical relevance of this interesting anatomy is discussed.
ABSTRACT
OBJECTIVE: Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. METHODS: We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. RESULTS: Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12-26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. CONCLUSION: Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Intraoperative Care/methods , Pulmonary Artery/surgery , Pulmonary Valve Stenosis/surgery , Stents , Adolescent , Adult , Cardiac Surgical Procedures/methods , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/surgery , Hospital Mortality , Humans , India , Infant , Male , Patient Safety , Pulmonary Valve Stenosis/diagnostic imaging , Reoperation/methods , Retrospective Studies , Risk Assessment , Survival Rate , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/surgery , Treatment Outcome , Ultrasonography , Young AdultABSTRACT
A four-year-old girl presented with superior vena cava (SVC) type of sinus venosus defect, right upper pulmonary vein draining into right SVC-right atrium junction, left upper lobe pulmonary veins draining into the lower part of persistent left SVC (LSVC), and a patent ductus arteriosus. The anomalous pulmonary venous drainage to LSVC was overlooked in the preoperative evaluation and was found intraoperatively. Warden procedure was performed for right-sided veins. Lower LSVC draining the anomalous pulmonary veins was anastomosed to the left atrial appendage. The short stump of LSVC was diverted to left pulmonary artery. Anomalous pulmonary venous connections to LSVC are rare. Embryology of venous development is analyzed with respect to this rare anomaly, and options for surgical correction are discussed.
Subject(s)
Abnormalities, Multiple/surgery , Ductus Arteriosus, Patent/surgery , Heart Septal Defects, Atrial/surgery , Pulmonary Veins/surgery , Vena Cava, Superior/surgery , Abnormalities, Multiple/diagnosis , Cardiac Surgical Procedures/methods , Cardiopulmonary Bypass , Child, Preschool , Ductus Arteriosus, Patent/diagnosis , Female , Heart Septal Defects, Atrial/diagnosis , Humans , Incidental Findings , Pulmonary Veins/abnormalities , Treatment Outcome , Vascular Surgical Procedures/methods , Vena Cava, Superior/abnormalitiesABSTRACT
We describe rare cases of common arterial trunk (truncus arteriosus communis) with unbalanced atrioventricular septal defect, left ventricular hypoplasia, and restrictive ventricular septal defect. The embryology, hemodynamics, and the clinical implications of this complex combination are discussed.
