Pulmonary-to-systemic flow ratio: lung cancer with partial anomalous pulmonary venous return.

There are only limited reports on pulmonary resection complicated with partial anomalous pulmonary venous connection. Preoperative partial anomalous pulmonary venous connection was overlooked in approximately 50% of these reports, while most cases of were located on the same side as the pulmonary resection. We examined the prevalence of overlooked partial anomalous pulmonary venous connection and determined appropriate measures to avoid misdiagnosis. We retrospectively reviewed the records and computed tomography data of consecutive patients who underwent pulmonary resection at the University of Yamanashi Hospital between 2006 and 2019. We re-evaluated the computed tomography images in horizontal and coronal views, focusing on the four common sites of partial anomalous pulmonary venous connection. Further, we conducted a literature review of studies that reported partial anomalous pulmonary venous connection cases. Among the 1389 patients who underwent pulmonary resection, 1205 were enrolled. There were five partial anomalous pulmonary venous connection cases (0.41%). Two were diagnosed through re-evaluation. The partial anomalous pulmonary venous connection was located between the right upper lobe and the superior vena cava in four patients (80%). All patients underwent left superior segmentectomy, and none experienced postoperative heart failure or hypoxia. In the literature, the incidence rates of partial anomalous pulmonary venous connection observed by computed tomography (0.1-0.25%) were lower than those observed by autopsy (0.62%) and angiography (0.82%). There may be a considerable number of overlooked partial anomalous pulmonary venous connection cases. Therefore, particularly the superior vena cava should be carefully monitored in preoperative computed tomography examinations.

The population of adults with congenital heart disease (ACHD) has increased dramatically over the past few decades, with many people who are now middle-aged and some in the geriatric age range. This improved longevity is leading to increased use of the medical system for both routine and episodic care, and caregivers need to be prepared to diagnose, follow up, and treat the older adult with congenital heart disease (CHD). The predictable natural progression of CHD entities and sequelae of previous interventions must now be treated in the setting of late complications, acquired cardiac disease, multiorgan effects of lifelong processes, and the unrelenting process of aging. Despite the advances in this field, death rates in the population from 20 to >70 years of age may be twice to 7 times higher for the ACHD population than for their peers.1 This American Heart Association (AHA) scientific statement will focus on the older adult (>40 years old) with CHD. It is meant to be complementary to the 2008 American College of Cardiology (ACC)/AHA guidelines for ACHD and orient the reader to the natural history, ramifications of childhood repair, and late initial diagnosis of CHD in the older adult. This population with CHD is unique and distinct from both the pediatric and young adult populations with CHD. Much of the information we provide is from scientific research combined with clinical experience from longitudinal care. We emphasize that this is the beginning of a discussion regarding this rapidly growing population, and continued research aimed at the progression of disease and complications reviewed here is necessary to advance the field of ACHD with the scientific rigor it deserves. ACHD encompass a broad range of presentations. There are people who are diagnosed for the first time in adulthood, as well as those with prior palliative repair …

The Common Trunk of the Left Pulmonary Vein Injured Incidentally During Lung Cancer Surgery

Contemporary management of right atrial isomerism: Effect of evolving therapeutic strategies

* ALL: : acute lymphoblastic leukemia CT: : computed tomography IVC: : inferior vena cava NA: : neonatal appendicitis NEC: : necrotizing enterocolitis WBC: : white blood cell A 7-day-old boy born at term is brought to the emergency department by his foster mother for refusal to feed for ∼20 hours and increased crying, although he is intermittently consolable. When given his bottle, the infant starts to suck but then cries as though in pain. He has not vomited, and his last bowel movement was yesterday. The stool has been moderately well formed without blood or mucus, and wet diapers have continued. There is no history of respiratory symptoms, lethargy, rashes, or jaundice. The biological mother is a 27-year-old woman with a known history of previous drug abuse; she had received some prenatal care. This infant was born by scheduled cesarean delivery. Initial physical examination reveals a crying but consolable neonate. His temperature is 37.7°C, heart rate is 170 beats/minute, and respiratory rate is 56 breaths/minute; the remainder of his findings are normal. His complete blood count (white blood cell [WBC] 11.7 × 109/L, 78.5% neutrophils, 11.4% monocytes, 9.8% lymphocytes), serum concentrations of electrolytes and glucose, urinalysis, and cerebrospinal fluid studies are normal. Cultures are obtained. An abdominal radiograph is normal and abdominal ultrasonography reveals trace pelvic fluid. He is given a bolus of normal saline and is started on antibiotics to treat possible sepsis. A few hours after admission, repeat examination is concerning for inconsolability, poor suck reflex, and lethargy. His abdomen is distended, firm, and tender to palpation. Bowel sounds are normal. Further studies are performed that reveal the diagnosis. A previously healthy 10-month-old boy is seen for a 2-week history of an erythematous left eye with tearing. Earlier, he was diagnosed as having conjunctivitis at an urgent care clinic and was treated with a 10-day course of polymyxin B/trimethoprim eye drops without improvement. He has felt warm intermittently but has not had a …

There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33mL/m(2) vs. 118 ± 30mL/m(2)), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation.

Chylopericardium is the collection of lymph fluid inside the pericardial cavity. The incidence of chylopericardium is very low, as this diagnosis is rarely reported following cardiac procedures in children. While some reports were published worldwide on isolated chylopericardium after cardiac surgeries for diverse reasons, it has never been reported after repair for partial anomalous pulmonary venous return. In addition, management of this diagnosis ends up being surgical with minimal concentration on medical treatment which proved unsuccessful. We present a medical approach with corticosteroids as an effective method to treat isolated chylopericardium. In this manuscript, we present an approach to treat isolated post-operative chylopericardium in a child following repair of partial anomalous pulmonary venous return. Chylous drainage responded to corticosteroids and completely ceased. There was no need for surgical intervention. Until now, isolated chylopericardium has never been reported to occur with partial anomalous pulmonary venous return repair. A review of the literature showed that most patients follow a conservative approach consisting of diuretics and non-steroidal anti-inflammatory agents with some of them undergoing surgical re-intervention. With future research on the topic still needed, we hope that this will encourage physicians worldwide to consider administering a trial of corticosteroids as an option to treat chylopericardium.

Lung Cancer Surgery in Partial Anomalous Pulmonary Venous Connection Patients

Total anomalous pulmonary venous connection: Results of surgical repair of 100 patients at a single institution

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital defect where pulmonary venous plexus fails to connect with the left atrium (LA). Surgical repair is the primary treatment for TAPVC, but factors influencing outcomes are not fully understood. This study investigates the early outcomes of surgical repair for TAPVC and associated factors. A retrospective cohort analysis was conducted on TAPVC patients who underwent surgical repair between 2012 and 2022. Data were collected from medical records and supplemented with phone call validation. Demographic characteristics, surgical data, diagnostic tests, and outcomes were analyzed. Statistical analysis included chi-square, t-tests, and multivariate logistic regression using SPSS. A total of 88 patients underwent surgical repair for TAPVC, resulting in a mortality rate of 21.6%. Weight and bypass time were significantly associated with patient survival. Female patients had a higher likelihood of death. The anatomic type did not significantly influence mortality. Patients with pulmonary venous obstruction (PVO) experienced a higher mortality rate. Notably, ligation of the vertical vein in supracardiac and infracardiac types was associated with lower mortality. In conclusion, our study identifies several key factors contributing to higher mortality rates following TAPVC surgery, including low weight, female gender, prolonged bypass time, and preoperative vein obstruction. Highlighting the significance of surgical technique, particularly the sutureless approach, we advocate for its meticulous consideration to achieve improved outcomes. Furthermore, our findings indicate a potential decrease in mortality associated with vertical vein ligation, which may mitigate the risk of post-repair heart failure. We suggest further rigorous studies to gain comprehensive insights into TAPVC surgical interventions.

The purpose of this study was to determine the lobar distribution and associated radiologic/clinical findings of partial anomalous pulmonary venous return (PAPVR) in the adult population using multidetector computed tomography (MDCT). The radiology information database was queried for patients with PAPVR diagnosed on chest computed tomography. Forty-seven cases of PAPVR were retrospectively identified from 45,538 contrast-enhanced chest computed tomography examinations performed over an 8-year period. Diagnostic findings were confirmed via consensus review by 2 cardiothoracic radiologists. Medical charts were evaluated for ancillary radiographic data, cardiopulmonary signs and symptoms, and subsequent surgical interventions. Calculated disease prevalence was 0.1%, with mean patient age of 58 years and a 58% female predominance. PAPVR was observed with 47% frequency in the left upper lobe, 38% right upper lobe (RUL), 13% right lower lobe, and 2% left lower lobe. Among cases of RUL PAPVR, 42% were associated with sinus venosus atrial septal defect (ASD). Other reported anomalies were right-sided volume overload (47%), isolated upper lobe PAPVR (29% left and 5% right), bilateral PAPVR (4%), scimitar syndrome (13%), persistent left superior vena cava (9%), and azygos continuation of the inferior vena cava (4%). Reported cardiopulmonary signs/symptoms and imaging modalities other than MDCT were neither sensitive nor specific for PAPVR. Surgical repair was performed in 21% of cases and included ASD patching, intracardiac baffle, anomalous vein anastomosis, systemic vein translocation, and Warden procedure. This represents the largest and only consecutive retrospective study of PAPVR in adults to date. Left upper lobe PAPVR was the most frequent location detected on MDCT, whereas RUL PAPVR was slightly less common and moderately associated with sinus venosus ASD. Utilization of contrast-enhanced studies and MDCT technology has enabled improved detection and characterization of PAPVR for early diagnosis and/or intervention.

ABSTRACTINTRODUCTIONPartial anomalous pulmonary venous connections (PAPVC) are rare. We report a case of right pneumonectomy for right lower lobe lung cancer, wherein a PAPVC was detected in the right upper lobe vein before surgery.CASE PRESENTATIONA 71-year-old man was diagnosed with a mass in the right lower lobe on chest CT. Non-small-cell lung cancer was diagnosed using bronchoscopy. Right bilobectomy (middle and lower lobes) was planned to secure a margin for resection due to hypoplasia of the middle lobe; however, preoperative contrast-enhanced CT revealed a PAPVC involving the right upper lobe. If a PAPVC is identified in a non-resected lung lobe, the patient is at risk of postoperative right heart failure. In cases of PAPVC in a non-resected lobe with Qp/Qs ≥1.5, preoperative or intraoperative revascularization is recommended. Echocardiography demonstrated a pulmonary to systemic flow ratio (Qp/Qs) of 1.39; however, right heart catheterization showed an increase in Qp/Qs to 1.66. Therefore, we considered repairing the right upper pulmonary vein. However, owing to the unstable position of the right upper lobe and the length of the repaired vessel, we performed a right pneumonectomy considering the risk of vascular flexion and occlusion. The postoperative course was uneventful, and echocardiography performed 3 months after the procedure revealed an ejection fraction of 57%.CONCLUSIONSIn the present case, by assessing Qp/Qs using both echocardiography and right heart catheterization, we determined an appropriate surgical approach. However, right pneumonectomy is a risk factor for right-sided heart failure, and limited resection or nonsurgical treatment should be considered in certain cases. The presence of PAPVC in a non-resected lung requires caution when selecting the surgical approach. In cases of PAPVC, detailed preoperative CT evaluation is essential.

Objective This retrospective cohort study aims to evaluate and compare the prognosis of surgical repair for total anomalous pulmonary venous connection(TAPVC) with different drainage type. Methods From January 2006 to December 2013, 328 consecutive patients were enrolled in this study. The distribution of the defects was 109 cases with cardiac, 161 with supracardiac, 32 with infracardiac, and 26 with mixed type of the drainage into the systemic circulation. The clinical records of all the patients were reviewed. Studied variables were extracted from the clinical records. Followed-up was conducted at an interval of 1 month, 3 months, 6 months and then once a year post-operation. Prevalence of peri-operative conditions were compared among four different types. Studied endpoints was defined by postoperative total death or pulmonary venous obstruction(PVO), which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model, adjusted by different surgical strategy, emergency operation, preoperative-PVO, neonates, weight, combing with other complex cardiac defects, NYHA cardiac function, severe pulmonary hypertension and severe tricuspid regurgitation. Results There were significant discrepancy of preoperative conditions among four types of TAPVC. Patients with infracardiac TAPVC presented the most critical symptoms and clinical indexes, which included having largest proportion of neonates, preoperative PVO, severe NYHA grading, pulmonary hypertension and tricuspid regurgitation, having lowest body weight at operation and youngest age. The cardiopulmonary bypass time, aortic crossclamp time and mechanical ventilation time were significantly longer in infracadiac and mixed TAPVC comparing to the other two types. For early mortality(death in hospital), infracadiac(9.4%) and mixed(11.5%) TAPVC demonstrated higher rates of death than cardiac(4.6%) and supracardiac(7.5%)TAPVC, although had no statistical significance. For intermediate-term results, mortality in infracadiac(21.9%) and mixed(30.8%) TAPVC were significantly higher than cardiac(8.3%)and supracardiac(11.8%)TAPVC. Reoperation was more frequently required in mixed(19.2%), then infracadiac(15.6%)TAPVC. Mixed and infracadiac types are independent risk factors for TAPVC prognosis, after adjusting by the confounding factors. Conclusion Mixed and infracadiac types are independent risk factors for postoperative death and PVO among TAPVC patients. This study provided evidence for clinical assessment and management strategy for different types of TAPVC. Key words: Heart surgery; Total anomalous pulmonary venous connection; Pulmonary venous obstruction

Percutaneous Atrioseptostomy for Right Heart Failure After Left Pneumonectomy

Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection