Original ArticlesRelentless pulmonary vein stenosis after repair of total anomalous pulmonary venous drainage☆
Section snippets
Methods
Review of the cardiovascular surgical database at the Hospital for Sick Children of Toronto between July 1982 and July 1996 identified 170 patients undergoing primary surgical repair of total anomalous pulmonary venous return. Of these 170 patients, 129 survived more than 30 days after initial repair (24% early mortality). Thirteen of the 129 survivors (10%) experienced PR-PVS, defined as pulmonary vein stenosis requiring intervention and presenting more than 30 days after initial TAPVD repair.
Results
A total of 170 patients were identified with TAPVD. Of this group, 129 survived more than 30 days after repair, and of these survivors, 13 patients had recurrent pulmonary vein stenosis. The anatomic breakdown of the entire cohort and the patients with pulmonary vein stenosis is summarized in Table 2. Within the smaller group of 13 patients with PR-PVS, the infracardiac and mixed subtypes were most common (p < 0.05). Of note, 1 of the 2 patients with a mixed subtype who had recurrent stenosis
Comment
Repair of total anomalous pulmonary venous return has been noted by Bando and coworkers [2] to be associated with decreasing perioperative morbidity in more recent years. This improvement in early mortality is thought to reflect evolving management strategies and operative technique. Despite such advances, however, in most series a small but persistent percentage of patients will return after repair with pulmonary vein stenosis. In the series by Bando and associates [2], 99 patients had
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