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3, Приложение . 2021

The treatment of choice for urgent intervention in children with severe/critical TAPVC

Abstract

Background. As the result of anomalous pulmonary veins connection, the direct preload of LV is absent in patients with TAPVC, so that systemic output depends on atrial septal defect's size. The obstructive pulmonary venous blood flow is a risk factor leading to hemodynamic instability of the patients, which affects negatively to survival. We evaluated the results of urgent surgical treatment of the patients with severe/critical TAPVC under bypass as a primary intervention.

Material and methods. 46 patients with severe/critical TAPVC were included in this retrospective multicentered study. The primary open heart surgery under bypass was done in 34 cases, balloon atrioseptostomy (BAS) as a palliative intervention followed by open heart surgery under bypass was performed in 12 cases. The factors of pre-, intra- and postoperative period were analyzed in both groups of the patients.

Results. The preoperative artificial ventilation was required in 32 (69.5%) patients, inotropic support - in 19 (41.3%) patients before surgery. Although primary BAS was done in 12 patients, only in 5 cases the open heart surgery was delayed more than 24 hours after BAS. Both analyzed groups of the patients were comparable between each other and have no statistically significant differences in intra- and postoperative period, except shorter time of inotropic support and overall duration of hospitalization in the primary bypass group. The assessment of the result of the surgery including the velocity on the anastomosis, LV status, heart rhythm showed comparable results without statistically significant differences.

Conclusion. The primary open heart surgery under bypass can be considered as a method of choice for urgent intervention in severe\critical TAPVC patients.

Keywords:total anomalous pulmonary venous connection, urgent intervention

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Morozov A.A., Movsesyan R.R., Boriskov M.V., Belov V.A., Teplov P.V., Latypov A.K., Grekhov E.V., Tkachenko I.A., Miller A.Yu., Titov A.M., Didyk V.P. The treatment of choice for urgent intervention in children with severe\critical TAPVC. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (3). Supplement: 58-63. DOI: https://doi.org/10.33029/2308-1198-2021-9-3suppl-58-63 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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