Hostname: page-component-77c89778f8-gvh9x Total loading time: 0 Render date: 2024-07-20T15:21:16.113Z Has data issue: false hasContentIssue false
  • English
  • Français

A novel percutaneously adjustable device for ligature of the vertical vein in the setting of obstructive totally anomalous pulmonary venous connection

Published online by Cambridge University Press:  18 June 2007

Ujjwal K. Chowdhury ,
Anand Mishra ,
Anita Saxena ,
Shyam S. Kothari ,
Amber Malhotra ,
Rajiv Mahajan ,
Jayanth H.V. Honnakere  and
Panangipalli Venugopal
Ujjwal K. Chowdhury*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anand Mishra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Anita Saxena
Affiliation:
Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Amber Malhotra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Rajiv Mahajan
Affiliation:
Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Jayanth H.V. Honnakere
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Dr Ujjwal K. Chowdhury, M.Ch., Diplomate NB, 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-mail: ujjwalchow@rediffmail.com, ujjwalchowdhury@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

A patent vertical vein might be desirable in patients with obstructive totally anomalous pulmonary venous connection with pulmonary hypertension, in order to decrease perioperative pulmonary arterial pressure and avoid pulmonary hypertensive crises. A subset of patients with an unligated vertical vein requires interruption of the vein due to the development of significant left-to-right shunt and right heart failure. We describe here a new device, permitting adjustable ligation of the vertical vein, which permits us to avoid multiple reoperations.

Patients and methods

In five patients, aged 2, 4, 3, 4, and 3 months respectively, and undergoing rechannelling of totally anomalous pulmonary venous connection with an unligated vertical vein, were treated with a device permitting adjusted ligation of the vertical vein over the course of postoperative congestive cardiac failure.

Results

There was no early or late death. Postoperatively, all ligatures were tightened gradually over a period of 24 to 96 hours, maintaining stable haemodynamics. At a mean follow-up of 55.40 months, there was no evidence of congestive heart failure in any patient, the clinical risk score varying from zero to 2, and no requirement of anti-failure medications. Computed tomographic angiograms during follow-up revealed absence of flow through the vertical vein, and ruled out distortion of the left upper pulmonary and left brachiocephalic veins.

Conclusion

Use of a percutaneously adjustable device to ligate the vertical vein allows gradual tightening or loosening of the ligature under optimal physiologic conditions, without re-opening the sternum, or having to resort to another thoracotomy once the reactive components of pulmonary hypertension disappear.

Keywords

Congenital heart diseaseacyanoticanomalous pulmonary venous drainagecardiac anatomycongestive heart failure
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 380 - 386
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hancock Friesen, CL, Zurakowski, D, Thiagarajan, RR, et al. . Totally anomalous purmonary venous connection: An analysis of current management strategies in a single institution. Ann Thorac Surg 2005; 79: 596–606.CrossRefGoogle Scholar
2. Michielon, G, Di Donato, RM, Pasquini, L, et al. . Totally anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur J Cardiothorac Surg 2002; 22: 184–191.CrossRefGoogle Scholar
3. Mustard, WT, Keith, JD, Trusler, GA. Two-stage correction of totally anomalous pulmonary venous drainage in childhood. J Thorac Cardiovasc Surg 1962; 44: 477–485.CrossRefGoogle Scholar
4. Cope, JT, Banks, BS, McDaniel, NL, Shockey, KS, Nolan, SP, Kron, IL. Is vertical vein ligation necessary in repair of totally anomalous pulmonary venous connection? Ann Thorac Surg 1997; 64: 23–29.CrossRefGoogle Scholar
5. Mathew, R, Thilenius, OG, Replogle, RL, Arcilla, RA. Cardiac function in totally anomalous pulmonary venous return before and after surgery. Circulation 1977; 55: 361–370.CrossRefGoogle Scholar
6. JrGraham, TP, Jarmakani, JM, JrCanent, RV. Left heart volume characteristics with a right ventricular volume overload totally anomalous pulmonary venous connection and large atrial septal defect. Circulation 1972; 45: 389–396.CrossRefGoogle Scholar
7. Caspi, J, Zalstein, E, Zuker, N, Appelbaum, A. Adjustable suture of the vertical pulmonary vein for repair of infracardiac totally anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 1995; 109: 389–396.CrossRefGoogle Scholar
8. Ross, RD, Bollinger, RO, Pinsky, WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol 1992; 13: 72–75.CrossRefGoogle ScholarPubMed
9. Chowdhury, UK, Subramaniam, G, Joshi, K, et al. Rechanelling of total anomalous pulmonary venous connection with or without vertical vein ligation: Results and guidelines for candidate selection. J Thorac Cardiovasc Surg 2007; 133: 1286–1294.CrossRefGoogle ScholarPubMed
10. Caspi, J, Pettitt, TW, Fontenot, EE, et al. . The beneficial hemodynamic effects of selective patent vertical vein following repair of obstructed totally anomalous pulmonary venous drainage in infants. Eur J Cardiothorac Surg 2001; 20: 830–834.CrossRefGoogle Scholar
11. Shah, MJ, Shah, S, Shankargowda, S, Krishnan, U, Cherian, KM. Left-to-right shunt: A serious consequence of totally anomalous pulmonary venous connection repair without ligation of vertical vein. Ann Thorac Surg 2000; 70: 971–973.CrossRefGoogle Scholar
12. Jegier, W, Charrette, E, Dobell, ARC. Infradiaphragmatic anomalous pulmonary venous drainage: normal hemodynamics following operation in infancy. Circulation 1967; 35: 396–400.CrossRefGoogle ScholarPubMed
13. JrHammon, JW, JrBender, HW, JrGraham, TP, JrBoucek, RJ, Smith, CW, JrErath, HG. Total anomalous pulmonary venous connection in infancy: ten years’ experience including studies of postoperative ventricular function. J Thorac Cardiovasc Surg 1980; 80: 544–551.CrossRefGoogle ScholarPubMed
14. Taylor, RR, Covell, JW, Sonnenblick, EH, JrRose, J. Dependence of ventricular distensibility of filling of the opposite ventricle. Am J Physiol 1967; 213: 711–718.CrossRefGoogle ScholarPubMed
15. Haworth, SG, Reid, L. Structural study of pulmonary circulation and of heart in total anomalous pulmonary venous return in early infancy. Br Heart J 1977; 39: 80–92.CrossRefGoogle ScholarPubMed
16. Corno, A, Giamberti, A, Carotti, A, Giannico, S, Marino, B, Marcelletti, C. Total anomalous pulmonary venous connection: surgical repair with double patch technique. Ann Thorac Surg 1990; 49: 492–494.CrossRefGoogle ScholarPubMed
17. Cobanoglu, A, Menashe, VD. Totally anomalous pulmonary venous connection in neonates and young infants: repair in current era. Ann Thorac Surg 1993; 55: 43–49.CrossRefGoogle Scholar
18. Bando, K, Turrentine, MW, Ensing, GJ, et al. . Surgical management of totally anomalous pulmonary venous connection: thirty-year trends. Circulation 1996; 94 (Suppl II): II-12–16.Google Scholar
19. Choudhary, SK, Bhan, A, Sharma, R, et al. . Repair of totally anomalous pulmonary venous connection in infancy: Experience from a developing country. Ann Thorac Surg 1999; 68: 155–159.CrossRefGoogle Scholar