The outcome of the vertical vein left intact during the surgery for total anomalous venous connection and its effects on ventricular functions

Abstract

We examined the fate of intact vertical vein during long-term follow-up and its effects on ventricular functions. Eighty one patients with all types of total anomalous pulmonary venous connection (TAPVC) were operated. Thirty-one patients with supracardiac type TAPVC were examined in our retrospective cohort study. Groups were evaluated with respect to left ventricle area, volume, end-systolic, end diastolic diameter, early and late term mortality and properties of pulmonary hypertensive crisis. Vertical vein was left open in 14 patients and it was ligated in 17 patients. Wilcoxon rank and Mann- Whitney U tests were used to compare variables between groups. After mean follow up of 48±36 months, vertical vein closed spontaneously in 3 patients. Two of them were closed surgically due to elevated shunt flow and there was spontaneous closure in one patient who had the highest pulmonary artery pressure amongst others postoperatively. Preoperative left ventricular area, volume, end-systolic diameter and end-diastolic diameter values of the patients increased from 3.5± 0.9 mm(2)-2.9±0.9 mm(3)-14±5 mm-8±4.5 mm to 8±3.3 mm(2)-16±8.7 mm(3)-27±6.7 mm-17±4.8 mm at the postoperative period in Group 1, and from 6.8±3.5 mm(2)-8.4±8.7 mm(3)-15±6.4 mm-9±5.3 mm to 7.4±5.2 mm(2)-16±1.7 mm(3)-21.7±5 mm-13.5±4.1 mm in Group 2, respectively (p=0.02, p=0.039, p=0.054, and p=0.07, respectively). Vertical vein remains intact in most of the patients and may be closed spontaneously in patients with elevated pulmonary resistance. Intact vertical vein both decompresses the left ventricular cavity in patients with decreased left ventricular compliance until the ventricular muscle adapts to new workload and improves ventricular functions on long term follow up. Therefore, we conclude that vertical vein should be left open in selected patients.