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A suggested new surgical classification for mixed totally anomalous pulmonary venous connection

Published online by Cambridge University Press:  25 June 2007

Ujjwal K. Chowdhury ,
Amber Malhotra ,
Shyam S. Kothari ,
Sri Krishna Reddy ,
Anand K. Mishra ,
Kizakke K. Pradeep  and
Panangipalli Venugopal
Ujjwal K. Chowdhury*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Amber Malhotra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Sri Krishna Reddy
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Anand K. Mishra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Kizakke K. Pradeep
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Dr Ujjwal K. Chowdhury, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. Tel: +91 11 26588700, 91 11 26588500 Ext. 4835; Fax: +91 11 26588663, 26588641 E-mails: ujjwalchow@rediffmail.com, ujjwalchowdhury@gmail.com
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Abstract

The morphologic variations of mixed totally anomalous pulmonary venous connection are many and varied. In this review, we give an account of all cases previously described as mixed totally anomalous pulmonary venous connection, analyzing in detail those cases where an accurate anatomical description was provided. We identified 182 suitable cases, from 54 investigations, and reviewed the clinical presentation, anatomic variations, diagnostic features, and management of the patients described.

Cross-sectional echocardiography, and cardiac catheterization, provided the necessary diagnostic information, and defined the anatomy before surgery in 139 patients. Magnetic resonance imaging and computerized tomographic angiography had been used for further clarification of the pulmonary venous anatomy. An obstructive pattern of drainage, involving one or more pulmonary veins, had been described in over half of the patients. We then grouped the lesions into categories that have a bearing on the appropriate surgical approach, discussing the appropriate repair for each group. For the overall group, the operative mortality remains high, at 22.9%. We submit that an increased appreciation of various types of mixed totally anomalous pulmonary venous connection may well contribute to improved future surgical management.

Keywords

Congenital heart defectspulmonary hypertensionpulmonary vascular obstruction
Type
Review Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 342 - 353
Copyright
Copyright © Cambridge University Press 2007

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References

1. Delius, RE, De Leval, MR, Elliott, WJ, Stark, J. Mixed total pulmonary venous drainage: still a surgical challenge. J Thorac Cardiovasc Surg 1996; 112: 1581–1588.CrossRefGoogle ScholarPubMed
2 JrWilson, WR, Ilbawi, MN, DeLeon, SY, et al. . Technical modifications for improved results in total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg 1992; 103: 861–871.CrossRefGoogle ScholarPubMed
3. Oelert, H, Schafers, HJ, Stegmann, T, Kallfelz, HC, Borst, HG. Complete correction of total anomalous pulmonary venous drainage: experience with 53 patients. Ann Thorac Surg 1986; 41: 392–394.CrossRefGoogle ScholarPubMed
4. Whight, CM, Barratt-Boyes, BG, Calder, AL, Neutze, JM, Brandt, PW. Total anomalous pulmonary venous connection: long term results following repair in infancy. J Thorac Cardiovasc Surg 1978; 75: 52–63.CrossRefGoogle ScholarPubMed
5. Choudhary, SK, Bhan, A, Sharma, R, et al. . Total Anomalous Pulmonary Venous Connection: Surgical Experience in Indians. Indian Heart J 2001; 53: 754–760.Google ScholarPubMed
6. Imoto, Y, Kado, H, Asou, T, Shiokawa, Y, Tominaga, R, Yasui, H. Mixed type of total anomalous pulmonary venous connection. Ann Thorac Surg 1998; 66: 1394–1397.CrossRefGoogle ScholarPubMed
7. Raisher, BD, Grant, JW, Martin, TC, Strauss, AW, Spray, TL. Complete repair of total anomalous pulmonary venous connection in infancy. J Thorac Cardiovasc Surg 1992; 104: 443–448.CrossRefGoogle ScholarPubMed
8. Ward, KE, Mullins, CE, Huhta, JC, Nihill, MR, McNamara, DG, Cooley, DA. Restrictive interatrial communication in total anomalous pulmonary venous connection. Am J Cardiol 1986; 57: 1131–1136.CrossRefGoogle ScholarPubMed
9. Soulie P. Cardiopathies congenitales. L’ Expansion Scientifique Francaise. 1952; Paris, p 272.Google Scholar
10. de Leval, M, Stark, J, Waterston, DJ. Mixed type of total anomalous pulmonary venous drainage: surgical correction in 3 infants. Ann Thorac Surg 1973; 16: 464–470.CrossRefGoogle ScholarPubMed
11. Fujimatsu, T, Tsunemoto, M, Shimada, M, et al. . Mixed type total anomalous pulmonary venous connection with the left upper pulmonary vein draining into the innominate vein and the other pulmonary veins into the coronary sinus-surgical correction in 2 infants. Nippon Kyobu Geka Gakkai Zasshi 1990; 38: 1093–1098.Google ScholarPubMed
12. Rodriguez-Collado, J, Attie, F, Zabal, C, et al. . Total anomalous pulmonary venous connection in adults. Long-term follow-up. J Thorac Cardiovasc Surg 1992; 103: 877–880.CrossRefGoogle ScholarPubMed
13. Dickinson, DF, Parmelazhagan, KM, Tweedic, MC, et al. . Total anomalous pulmonary venous connection – Repair using deep hypothermia and circulatory arrest in 44 consecutive infants. Br Heart J 1982; 48: 249–254.CrossRefGoogle ScholarPubMed
14. Goswami, KC, Shrivastava, S, Saxena, A, Dev, V. Echocardiographic diagnosis of total anomalous pulmonary venous connection. Am Heart J 1993; 126: 433–440.CrossRefGoogle ScholarPubMed
15. Huhta, JC, Gutgesell, HP, Nihill, MR. Cross Sectional echocardiographic diagnosis of total anomalous pulmonary venous connection. Br Heart J 1985; 53: 525–534.CrossRefGoogle ScholarPubMed
16. Saxena, A, Reddy, SC, Kothari, SS, Juneja, R, Venugopal, P, Shrivastava, S. Mixed variety of total anomalous pulmonary venous connection: diagnosis by 2D echocardiography and Doppler colour flow imaging. Indian Heart J 1999; 51: 65–68.Google ScholarPubMed
17. Chin, AJ, Sanders, SP, Sherman, F, Lang, P, Norwood, WI, Castaneda, AR. Accuracy of subcostal two-dimensional echocardiography in prospective diagnosis of total anomalous pulmonary connection. Am Heart J 1987; 113: 1153–1159.CrossRefGoogle Scholar
18. Blake, HA, Hall, RJ, Manion, WC. Anomalous pulmonary venous connection. Circulation 1965; 32: 406–414.CrossRefGoogle Scholar
19. Muller, WH. The surgical treatment of transposition of the pulmonary veins. Ann Surg 1951; 134: 683–693.CrossRefGoogle ScholarPubMed
20. Berdat, PA, Pfammattr, JP, Genyk, I, Carrel, TP. Modified repair of mixed total anomalous pulmonary venous connection. Ann Thorac Surg 2001; 71: 723–725.CrossRefGoogle ScholarPubMed
21. Winter, FS. Persistent left superior venacava: survey of world literature and report of thirty additional cases. Angiology 1954; 5: 90–132.CrossRefGoogle Scholar
22. Delisle, G, Ando, M, Calder, AL, et al. . Total anomalous pulmonary venous connection: report of 93 autopsied cases with emphasis on diagnostic and surgical considerations. Am Heart J 1976; 91: 99–122.CrossRefGoogle ScholarPubMed
23. Watanabe, T, Murashita, T, Oka, J, Hatta, E, Imamura, M, Yasuda, K. Mixed type of total anomalous pulmonary venous return: a rare pattern of pulmonary venous drainage. Kyobu Geka 2001; 54: 1041–1044.Google ScholarPubMed
24. Snellen, HA, Van Ingen, HC, Hoefsmit, ECM. Patterns of anomalous pulmonary venous drainage. Circulation 1968; 38: 45–63.CrossRefGoogle ScholarPubMed
25. El Said, G, Mullins, CE, Mc Namara, DG. Management of total anomalous pulmonary venous return. Circulation 1972; 45: 1240–1250.CrossRefGoogle ScholarPubMed
26. Sreeram, N, Walsh, K. Diagnosis of total anomalous pulmonary venous drainage by Doppler color flow imaging. J Am Coll Cardiol 1992; 19: 1577–1582.CrossRefGoogle ScholarPubMed
27. Arbona, GL, Kilman, JW, Van Aman, ME. Type IV total anomalous pulmonary venous connection. Unusual survival and review of the literature. J Cardiovasc Surg (Torino) 1982; 23: 49–53.Google ScholarPubMed
28. Carter, REB, Capriles, M, Noe, Y. Total anomalous pulmonary venous drainage. A clinical and anatomical study of 75 children. Br Heart J 1969; 31: 45–51.Google ScholarPubMed
29. Klint, R, Weldon, C, JrHartmann, A, Schad, N, Hernandez, A, Goldring, D. Mixed-type total anomalous pulmonary venous drainage: report of a successful surgical correction and review of the literature. J Thorac Cardiovasc Surg 1972; 63: 164–170.CrossRefGoogle Scholar
30. Hawkins, JA, Clark, EB, Doty, DB. Total anomalous pulmonary venous connection. Ann Thorac Surg 1983; 36: 548–560.CrossRefGoogle ScholarPubMed
31. Rubino, M, VanPraagh, S, Kadoba, K, Pessotto, R, Van Praagh, R. Systemic and pulmonary venous connections in visceral heterotaxy with asplenia : Diagnostic and surgical considerations based on seventy-two autopsied cases. J Thorac Cardiovasc Surg 1995; 110: 641–650.Google ScholarPubMed
32. Serraf, A, Belli, E, Roux, D, Sousa-Uva, M, Lacour-Gayet, F, Planche, C. Modified superior approach for repair of supracardiac and mixed total anomalous pulmonary venous drainage. Ann Thorac Surg 1998; 65: 1391–1393.CrossRefGoogle ScholarPubMed
33. Willi, H, Gasser, C. The clinical diagnosis of the triad: spleen agenesis, defects of the heart and vessels and situs inversus. Etudes Neo-Natales 1955; 4: 25–66.Google ScholarPubMed
34. Baumann, J. Agenesie des Milz, Herz-und Gefassmiss-bildungen und situs inversus partialis: ein charakteristischer Symptomenkomplex. Helv Paediatr Acta 1954; 9: 199–207.Google Scholar
35. Gott, VL, Lester, RG, Lillehei, CW, Varco, RL. Total anomalous pulmonary return an analysis of thirty cases. Circulation 1956; 13: 543–552.Google ScholarPubMed
36. Neligan, MC, O’Malley, E, Blake, S. Correction of type IV (mixed level) total anomalous pulmonary venous drainage. Thorax 1972; 27: 219–222.CrossRefGoogle ScholarPubMed
37. Ramsbotham, F. Malformations of the heart. Lond Med Phys J (NS) 1829; 6: 548.Google Scholar
38. Gomes, MMR, Feldt, RH, McGoon, DC, Danielson, GK. Total anomalous pulmonary venous connection: surgical considerations and results of operation. J Thorac Cardiovasc Surg 1970; 60: 116–122.CrossRefGoogle ScholarPubMed
39. Sepulveda, G, Lukas, DS, Steinberg, I. Anomalous drainage of pulmonary veins: clinical, physiologic and angiocardiographic features. Am J Med 1955; 18: 883–899.CrossRefGoogle ScholarPubMed
40. Kanjuh, VI, Katkov, H, Singh, A, Franciosi, RA, Helseth, HK, Edwards, JE. Atypical total anomalous pulmonary venous connection: Two channels leading to infracardiac terminations. Pediatr Cardiol 1989; 10: 115–120.CrossRefGoogle ScholarPubMed
41. Saxena, A, Fong, LV, Lamb, RK, Monro, JL, Shore, DF, Keeton, BR. Cardiac arrhythmias after surgical correction of total anomalous pulmonary venous connection: late follow-up. Pediatr Cardiol 1991; 12: 89–91.CrossRefGoogle ScholarPubMed
42. Bochdalek, J. Beschreibung einer sehr merkwurdigen Abweichung der Lungenvenen bei einem 4 Tage alten an Peritonitis verstorbenen Knaben. Vrtljschr Prakt Heilk 1858; 60: 160–170.Google Scholar
43. Arciprete, P, McKay, R, Watson, GH, Hamilton, DI, Wilkinson, JL, Arnold, RM. Double connections in total anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 1986; 92: 146–152.CrossRefGoogle ScholarPubMed
44. Ando, M, Takahashi, Y, Kikuchi, T. Total anomalous pulmonary venous connection with dysmorphic pulmonary vein: a risk for postoperative pulmonary venous obstruction. Interactive Cardiovascular and Thoracic Surgery 2004; 3: 557–561.CrossRefGoogle ScholarPubMed
45. Nakib, A, Moller, JH, Kanjuh, VI, Edwards, JE. Anomalies of pulmonary veins. Am J Cardiol 1967; 20: 77–90.Google Scholar
46. Chowdhury, UK, Kothari, SS, Airan, B. Unusual totally anomalous pulmonary venous connection in right isomerism and functionally univentricular heart. Cardiol Young 2001; 11: 75–78.CrossRefGoogle ScholarPubMed
47. Lee, ML, Wang, JK, Wu, MH, Chu, SH, Lue, HC. Unusual form of total anomalous pulmonary venous connection with double drainage. Pediatr Cardiol 1995; 16: 301–303.CrossRefGoogle ScholarPubMed
48. Boggs, JD, Reed, W. Congenital absence of the spleen. Northwestern Univ Med School Q Bull 1953; 27: 289–293.Google ScholarPubMed
49. Krishnan, P, Airan, B, Iyer, KS, et al. . Surgical treatment of total anomalous pulmonary venous connection. Ind Pediatr 1991; 28: 117–122.Google ScholarPubMed
50. Thompson, LD, McElhinney, DB, Reddy, VM, Jue, KL, Hanley, FL. Infradiaphragmatic totally anomalous pulmonary venous return with two separate descending veins in association with right atrial isomerism. Ann Thorac Surg 2000; 70: 1400–1402.CrossRefGoogle ScholarPubMed
51. Van Son, JAM, Hambsh, J, Mohr, FW. Modified repair of mixed anomalous pulmonary venous connection. Ann Thorac Surg 1998; 65: 1441–1442.CrossRefGoogle ScholarPubMed
52. Mohiuddin, SM, Levin, HS, Runco, V, Booth, RW. Anomalous pulmonary venous drainage: report of a successful surgical correction and review of literature. J Thorac Cardiovasc Surg 1966; 63: 164–170.Google Scholar
53. Shimazaki, Y, Nakano, S, Kato, H, et al. . Mixed type of total anomalous pulmonary venous connection with hemi-pulmonary vein atresia. Ann Thorac Surg 1993; 56: 1399–1401.CrossRefGoogle ScholarPubMed
54. Rebensburg, H. Eine merkwurdige Missbildung des Lungenvenen. Frankf Z Pathol 1932; 44: 137–143.Google Scholar
55. Choe, YH, Lee, HJ, Kim, HS, Ko, JK, Kim, E, Han, JJ. MRI of total anomalous pulmonary venous connections. J Comput Assist Tomogr 1994; 18: 243–249.CrossRefGoogle ScholarPubMed
56. Wang, JK, Li, YW, Chiu, IS, et al. . Usefulness of magnetic resonance imaging in the assessment of venoatrial connections, atrial morphology, bronchial situs and other anomalies in right atrial isomerism. Am J Cardiol 1994; 74: 701–704.Google ScholarPubMed
57. Kraybill, KA, JrLuca, RV. Abnormal pulmonary venous connection. In: Emmanouilides, GC, Reimenschneider, TA, Allen, HD, Gutgesell, HP (eds.). Heart Disease in Infants, Children, and Adolescents, including the Fetus and Adult, 5th edWilliams and Wilkins, Baltimore; 1995, pp 838–847.Google Scholar
58. Jaumin, P, Rubay, J, Moulin, D, et al. . Total anomalous pulmonary venous connection. Long-term results following repair under 3 months of age. J Cardiovasc Surg (Torino) 1989; 30: 11–15.Google ScholarPubMed
59. Jenkins, KJ, Sanders, SP, Coleman, L, Mayer, JE, Colan, SD. Pulmonary vein size and outcome in infants with totally anomalous pulmonary venous connection (Abstract). Circulation 1991; 84 (Suppl. 2): 351.Google Scholar
60. Brantigan, OC. Anomalies of the pulmonary veins. Their surgical significance. Surg Gynecol Obstet 1947; 84: 653–658.Google ScholarPubMed
61. Neill, CA. Development of the pulmonary veins with reference to the embryology of anomalies of pulmonary venous return. Pediatrics 1957; 18: 880.CrossRefGoogle Scholar
62. Darling, RC, Rothurney, WB, Craig, JM. Total pulmonary venous drainage into the right side of the heart: Report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest 1957; 6: 44–64.Google Scholar
63. Burroughs, JT, Edwards, JE. Total anomalous pulmonary venous connection. Am Heart J 1960; 59: 913–931.CrossRefGoogle ScholarPubMed
64. Smith, B, Frye, TR, JrNewton, WA. Total anomalous pulmonary venous return: Diagnostic criteria and a new classification. Am J Dis Child 1961; 101: 561–568.CrossRefGoogle Scholar
65. Babb, JD, McGlynn, TJ, Pierce, WS, Kirkman, PM. Isolated partial anomalous venous connection: a congenital defect with late and serious complications. Ann Thorac Surg 1981; 31: 540–543.CrossRefGoogle ScholarPubMed
66. Kirklin, JW. Surgical treatment of anomalous pulmonary venous connections. Mayo Clin Proc 1953; 28: 476–479.Google Scholar
67. Saalouke, MG, Shapiro, SR, Perry, LW, Scott LP, III. Isolated partial anomalous pulmonary venous drainage associated with pulmonary vascular obstructive disease. Am J Cardiol 1977; 39: 439–444.CrossRefGoogle ScholarPubMed
68. JrVan Meter, C, LeBlanc, JG, 3rdCulpepper, WS, Ochsner, JL. Partial anomalous pulmonary venous return. Circulation 1990; (Suppl. 4): IV195–IV198.Google ScholarPubMed