Management of pulmonary venous obstruction

• Published in: General thoracic and cardiovascular surgery Vol. 60; no. 12; pp. 785 - 791
• Main Authors: Yoshimura, Naoki, Fukahara, Kazuaki, Yamashita, Akio, Doki, Yoshinori, Doi, Toshio, Takeuchi, Katsunori, Higuma, Tomonori, Senda, Kazutaka, Toge, Masayoshi, Nagura, Saori
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.12.2012; Springer Nature B.V
• Subjects: Anatomy & physiology; Cardiac Surgery; Cardiology; Constriction, Pathologic - diagnosis; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Coronary vessels; Current Topics Review Article; Humans; Medicine; Medicine & Public Health; Mortality; Physiology; Postoperative Complications - diagnosis; Postoperative Complications - surgery; Pulmonary arteries; Pulmonary Veins - abnormalities; Pulmonary Veins - surgery; Pulmonary Veno-Occlusive Disease - diagnosis; Pulmonary Veno-Occlusive Disease - etiology; Pulmonary Veno-Occlusive Disease - surgery; Reoperation; Surgical Oncology; Surgical techniques; Thoracic Surgery; Vascular Surgical Procedures - methods; Veins & arteries; Pulmonary venous obstruction; Endovascular stenting; Sutureless repair; Total anomalous pulmonary venous connection
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-012-0154-8

Although improved surgical techniques have led to significantly better outcomes of surgery for total anomalous pulmonary venous connection, the risk of progressive pulmonary venous obstruction continues to be a clinical problem. Both obstructed total anomalous pulmonary venous connection and post-repair pulmonary venous obstruction are associated with a significant risk of recurrent obstruction or death, requiring reoperation for stenosis. In general, side to side anastomosis of the pulmonary venous confluence to the functional left atrium has been performed for supracardiac and infracardiac total anomalous pulmonary venous connection. Repair of total anomalous pulmonary venous connection to the coronary sinus invariably involved unroofing the coronary sinus, followed by pericardial patch closure of the atrial septal defect. Recently, sutureless technique has been adopted as the primary operation for the subgroups of patients that are thought to be at high risk for post-repair pulmonary venous obstruction, such as those with total anomalous pulmonary venous connection associated with right isomerism, infracardiac total anomalous pulmonary venous connection with small individual pulmonary veins, or mixed-type total anomalous pulmonary venous connection. Because the sutureless technique does not require direct anastomosis to the confluence, aggressive resection of the obstructed pulmonary venous tissue can be achieved, and surgically induced distortion of the suture line can be avoided, which may help to prevent subsequent pulmonary venous obstruction. Conventional management strategies for recurrent pulmonary venous obstruction have typically been associated with poor outcomes. Recent reports have supported the use of the sutureless technique to treat post-repair pulmonary venous obstruction.