Cardiosurgery: Anomalous pulmonary venous connection (total) — Surgical correction of total anomalous pulmonary venous connection. Treatment
Congenital anomalies of the pulmonary veins is a version of congenital malformations of the cardiovascular system. The symptoms are caused by mixing of arterial (oxygenated) and venous blood due to the anomalous pulmonary venous drainage (APVD). The disease is formed during the prenatal period and represents a confluence of pulmonary veins into the right atrium (sometimes - in the vena cava). In 80% patients, APVD is diagnosed in combination with the atrial septal defect.
Some patients with APVD do not report any complaints, and an anomaly is detected by chance in adulthood. In this case, treatment is not required, but need regular check-ups by a cardiologist.
Upon moderate signs of hemodynamic dysfunction manifested in the first months of life, a conservative therapy is conducted, which aims at postponement of surgical correction to a more advanced age. This tactic is due to better results of operative treatment. Postoperative, the mortality of children 6 to 7 years old is 5 times lower compared to the same indicator for infants.
Types of Surgeries
The technique of defect surgical correction is selected individually, taking into account the characteristics of the anomaly related to position of the large vessels and heart. The purpose of any surgery is separation of the venous and arterial blood flow.
- Creation of intraatrial tunnels eliminating the arterial blood from pulmonary veins to the left part of the heart.
- Transplantation of pulmonary veins to the left atrium is used when the pulmonary vein and vena cava are interconnected.
- Atrioseptotomiya is performed in a minimally invasive manner and is an emergency surgery for a serious condition of the newborn. The essence of the intervention is dissection of the interatrial septum to improve the patient's condition.
The patients with combined anomalies of the structure of heart and blood vessels undergo a simultaneous or gradual correction of each defect. In some cases, the atrial septal defect is not sutured, as some surgical methods use it for tunnels. In this case, the opening between the atria may be created artificially or expanded during surgery.
Timely treatment of congenital anomalies of the pulmonary veins allows achieving favorable results in 70-90% cases, depending on the defect type.Hide
See also for anomalous pulmonary venous connection (partiel):
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