Pulmonary Venous Branches Research Articles

Prevalence of anatomical variations in children with congenital lung malformations investigated by video recordings of thoracoscopic lobectomy

Background: Sufficient knowledge of anatomy including normal patterns and aberrant variations is crucial in thoracoscopic lobectomy for congenital lung malformations (CLMs). This study aimed to investigate the prevalence of anatomical variations and their correlations with surgical outcome. Methods: Video-recordings of thoracoscopic lobectomy performed for CLMs between 2009 and 2021 were reviewed. The incidences of surgically relevant variations, including abnormal branches of pulmonary arteries and veins, aberrant systemic arteries, and incomplete fissures (as classified by Craig) were assessed in comparison with the previously published reports. Moreover, multiple univariate analyses were performed to seek correlations between surgical finding and prolonged operative times and postoperative drainage. Results: Fifty-six lobectomies were reviewed. Variations of pulmonary arteries were more commonly seen in the left lung (29.6%) compared to right (10.7%). The prevalence of atypical pulmonary venous branches was similar between the right (13.8%) and left (18.5%). The right upper oblique fissure was frequently associated with Grade 2 incomplete fissure (44.8%). Grade 3 incomplete fissure was rare (3.4%) in the right lower oblique fissure but relatively common (14.3 – 18.5%) in other locations. Grade 4 incomplete fissure was limited to the right horizontal fissure (1.7%). Multiple univariate analyses demonstrated a significant correlation between any degree of incomplete fissure and prolonged operative time (p < 0.05), whereas no factor was identified to affect need for postoperative drainage. Conclusions: The incidence of anatomical variations in CLM patients was similar to that reported in adults. Review of intra-operative video footage was useful to closely evaluate and understand anatomical variations.

Modification of hemi-Fontan operation for patients with functional single ventricle and anomalous pulmonary venous connection to the superior vena cava: mid-term results.

Fontan candidates with mixed totally anomalous pulmonary venous connection often have postoperative pulmonary venous obstruction after cavopulmonary anastomosis. Because some pulmonary venous obstructions have no intimal hypertrophy at reoperation, we considered such pulmonary venous obstructions to be caused by 3D deformities arising from dissection or mobilization of the vessels, and hypothesized that keeping the pulmonary venous branches in a natural position could avoid such obstruction. Here, we evaluated a modified hemi-Fontan strategy consisting of minimal dissection with no division of vessels and patch separation between systemic and pulmonary venous flow. We retrospectively reviewed clinical records of infants with a functional single ventricle and supracardiac anomalous pulmonary venous connection who had undergone this procedure between 2002 and 2012. Nine infants underwent this procedure (median age, 5.6 months; range 3.2-30), all with right atrial isomerism and several pulmonary venous branches directly and separately connecting to the superior vena cava. In 5 patients, all pulmonary veins drained into the superior vena cava; in 1, the right pulmonary veins drained into the superior vena cava and in 3, a pulmonary venous branch drained into the superior vena cava. The median follow-up was 6.9 years (0.8-13 years). Three patients underwent reoperation for postoperative pulmonary venous obstruction caused by intimal hypertrophy; however, we confirmed no pulmonary venous obstruction caused by 3D deformities on the pulmonary venous branches connecting separately to the superior vena cava. Although 2 patients were effectively relieved from pulmonary venous obstruction, 1 died due to recurrent pulmonary venous obstruction. There was no late death and no sinus-node dysfunction. Eight patients underwent successful Fontan operation and catheterization. The median interval from the Fontan operation to the latest catheterization was 3.7 years (0.9-3.7 years). The median arterial oxygen saturation was 94% (91-97%) and the central venous pressure was 12 mmHg (8-14 mmHg); no deficiency of pulmonary arteries and veins was noted. For patients with functional single ventricle and anomalous pulmonary venous connections to the superior vena cava, our novel strategy of second-stage palliation could avoid postoperative pulmonary venous obstruction caused by 3D deformities, but may not eliminate pulmonary venous obstruction caused by intimal hypertrophy.

Relations between pulmonary venous branches and bronchial and arterial branches

Abstract Our results were obtained on 24 cases, 12 plastic molds and 12 dissections, examining the relations between the branches of origin of the pulmonary veins, and of their roots and trunks with the corresponding bronchuses and arteries. We assessed the situation of the superior and inferior right pulmonary veins, of the superior, middle and inferior lobes pedicles, together with the general assessment of the right pulmonary pedicles. Same is on the left. We cannot speak of a general sample that applies to the broncho-pulmonary vascular pedicles or to the relations between the pulmonary veins and their branches with broncho-arterial elements, as they are quite varied; they are characteristic of each lung lobe and even segment, being unable to assess standard relations only in the hilum. When variation in number occurs, even into the hilum we may have altered relations. Also is quite common that vascular branches may pass from one lobe to another, as long as the pulmonary fissures are rarely complete.

Transarterial coil embolization in the treatment of systemic arterial supply to normal segment of the lung without sequestration

We report a case of systemic arterial supply to normal segment of the lung without sequestration in a 27-year-old man with intermittent and massive hemoptysis. Multidetector-row CT scan demonstrated that dilated basal pulmonary venous branches and an aberrant artery connecting lower thoracic aorta and running toward the medial basal segment of right lung. Angiography showed a dilated aberrant artery with mild shunts to basal pulmonary venous branches connecting an anomalous pulmonary vein. Transarterial embolization of the aberrant artery was occluded by multiple 0.035-in. coils under balloon occlusion technique. Hemoptysis has been ceased after transarterial coil embolization which is useful and safe in the treatment of this rare congenital anomaly and may be alternative to surgical intervention.