Surgical treatment of infra-cardiac total anomalous pulmonary venous connection in 13 neonates

Abstract

Objective To evaluate the effectiveness of urgent surgical correction for infra-cardiac total anomalous pulmonary venous connection(TAPVC) in neonates. Methods From October 2009 to January 2015, 13 patients with infra-cardiac TAPVC received surgical correction.The age of patients ranged from 6 to 28 days[(15.08±7.42)days], the body weight ranged from 2.5 to 4.8 kg[(3.34±0.67) kg]. A median sternotomy was performed.Continuous cardiopulmonary bypass using bicaval cannulation with aortic cross-clamping and mild systemic hypothermia were used in all patients.Bi-atrial incision technique making anastomosis between the posterior left atrial wall and the vertical vein were employed in 3 cases.In the other 10 cases, the heart was elevated upward and to the right to expose the anomalous descending vertical vein to facilitate the anastomosis between the posterolateral left atrial wall and vertical vein. Results Emergent or subemergent operations were performed in all patients without surgical death.In the early stage after operation, delayed sternal closure was employed in 11 patients, pulmonary hypertension crisis occurred in 3 patients, small atrial septal defect was kept open for hemodynamic stabilization in 6 patients, temporary cardiac pacemaker for proper heart rate in 3 patients.All patients were uneventfully discharged except 2 patients died of severe low cardiac output syndrome.During the period of follow up, 2 patients presented with recurrent pulmonary infection and signs of pulmonary venous obstruction including the increased flow speed at the site of anastomosis.One of 2 patients was lost of follow up and the other patient was uneventfully discharged after the second operation.The rest 9 patients received postoperative follow up for 1 month to 5 years, echocardiography, X ray chest radiography, and electrocardiogram were performed during this period.As a result, all children had good cardiac function and with sinus rhythm on electrocardiogram and apparently reduced pulmonary congestion on radiography.No obstructive pulmonary venous return was observed on echocardiography. Conclusion Corrective operation for infra-cardiac TAPVC in neonate on urgent basis may provide favorite outcomes. Key words: Anomalous pulmonary venous connection; Cardiac surgical procedures; Congenital heart disease; Neonate