Reoperations after the correction of partial abnormal venous return: a clinical case series

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Abstract

Rationale: The surgical procedure for partial abnormal pulmonary venous return (PAPV) implies the formation of a tunnel between the orifices of the right pulmonary veins and the left atrial cavity with the interatrial septum repair. To avoid any obstruction of the tunnel, a direct anastomosis between the superior vena cava (SVC) and the right atrial appendage is placed in a number of cases. However, the reparative procedure is potentially associated with such complications as SVC stenosis and/or pulmonary vein stenosis.

 Aim: To present our experience of reoperations for stenosis of systemic and pulmonary veins after primary PAPV repair.

 Materials and methods: From 2014 to 2018, seven patients (boys, 4) with SVC stenosis and/or with stenosis of the right pulmonary veins have been admitted to the FCHMT (Kaliningrad). Their mean bodyweight was 29.1 kg (± 12.5 kg), mean age 9.3 years (± 3.6 years). Three patients had an isolated SVC stenosis. In two patients, there was a combination of SVC stenosis and pulmonary vein obstruction (from stenosis to complete occlusion); in one patient the right pulmonary vein stenosis had been caused by thrombosis. SVC stenosis with subaortal obstruction after the repair of double-outlet right ventricle was diagnosed in one case. In six patients, various procedures for correction of SVC and/or pulmonary vein stenosis were performed. Only in one case the obstruction of systemic veins, confirmed by cardiac catheterization, turned out to be non-significant, making a reoperation unnecessary. 

Results: There were no deaths in this patient group. Endovascular procedures were performed in two patients. In one case, there was an unsuccessful attempt of transluminal balloon angioplasty for SVC stenosis, with subsequent Warden procedure. In another case, a 16-year old patient with SVC stenosis and high pulmonary hypertension was admitted after two previous surgeries had failed. We used a homograft as SVC prosthesis; however, after one year, a re-stenosis was identified. In this case, a SVC stent placement was successful. Due to sick sinus syndrome at one year after the Warden procedure and the repair of pulmonary veins by a homograft, an implantation of electric cardiac pacemaker was necessary in one patient. 

Conclusion: The curative repair of partial abnormal venous return is a well-established surgical technique with satisfactory shortand long-term results. A potential complication of the procedure is an obstruction of systemic and pulmonary veins. To prevent such complications during primary defect repair, as well as with reoperations for vein stenosis, the Warden procedure seems effective and highly reproducible technique associated with lower surgical risks.

About the authors

D. S. Akatov

Federal Center of High Medical Technology

Author for correspondence.
Email: adeniss@mail.ru
ORCID iD: 0000-0002-8401-2556

Denis S. Akatov – MD, PhD, First Category Cardiovascular Surgeon, Department of Cardiovascular Surgery No. 3

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

V. A. Belov

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0002-0945-8208

Vyacheslav A. Belov – MD, First Category Cardiovascular Surgeon, Head of Department of Cardiovascular Surgery No. 3

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

O. N. Bukhareva

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0002-4041-4641

Olga N. Bukhareva – MD, PhD, First Category Cardiologist, Department of Cardiovascular Surgery No. 3

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

D. E. Khomich

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0002-1257-9043

Dina E. Khomich – MD, Cardiologist, Department of Cardiovascular Surgery No. 3

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

A. A. Makarov

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0003-3112-5191

Andrey A. Makarov – MD, Head of Department of Anaesthesiology and Resuscitation No. 1

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

S. N. Kotov

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0002-4027-4159

Sergey N. Kotov – MD, Head of Department of Functional Diagnostics

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

Yu. A. Schneider

Federal Center of High Medical Technology

Email: fake@neicon.ru
ORCID iD: 0000-0002-5572-3076

Yuri A. Schneider – MD, PhD, Chief Physician

4 Kaliningradskoe shosse, poselok Rodniki, Gur'evskiy rayon, Kaliningradskaya oblast', 238312, Russian Federation

Russian Federation

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Copyright (c) 2019 Akatov D.S., Belov V.A., Bukhareva O.N., Khomich D.E., Makarov A.A., Kotov S.N., Schneider Y.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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