Total anomalous pulmonary venous connection: Outcome of postoperative pulmonary venous obstruction

ObjectivePulmonary venous obstruction (PVO) is an important cause of late mortality in total anomalous pulmonary venous connection (TAPVC). We aimed to describe current practices for the management of postoperative PVO and the efficacy of the different interventional procedures.MethodsWe conducted a retrospective international collaborative population-based study involving 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. Patients with TAPVC born between January 1, 1998, and December 31, 2004, were identified. Patients with functionally univentricular circulation or atrial isomerism were excluded. All available data and images were reviewed.ResultsOf 406 patients undergoing repair of TAPVC, 71 (17.5%) had postoperative PVO. The diagnosis was made within 6 months of surgery in 59 (83%) of the 71 patients. In 12, serial imaging documented change in appearance of the pulmonary veins. Good-sized pulmonary veins can progress to diffusely small veins and rarely atresia. Patients presenting after 6 months had less severe disease; all are alive at most recent follow-up. Fifty-six (13.8%) of 406 patients underwent intervention for postoperative PVO: 44 had surgical treatment and 12 had an initial catheter intervention. One half underwent 1 or more reinterventions. Three-year survival for patients with postoperative PVO was 58.7% (95% confidence intervals, 46.2%-69.2%) with a trend that those having a surgical strategy did better (P = .083). Risk factors for death included earlier presentation after TAPVC repair, diffusely small pulmonary veins at presentation of postoperative PVO, and an increased number of lung segments affected by obstruction.ConclusionsPostoperative PVO tends to appear in the first 6 months after TAPVC repair and can be progressive. Early intervention for PVO may be indicated before irreversible secondary changes occur

Investigations of the Andean Past: Papers from the First Annual Northeast Conference on Andean Archaeology and Ethnohistory

The papers included in this volume represent fourteen of the twenty-three original papers presented at the First Annual Northeast Conference on Andean Archaeology and Ethnohistory held at Cornell University on November 13th and 14th, 1982. The papers are: The Preceramic Occupations of the Casma Valley, Peru by Michael A. Malpass, The Historical Development of a Coastal Andean Social Formation in Central Peru, 6000 to 500 B.C. by Thomas C. Patterson, Stone Tools in Ceramic Contexts: Exploring the Unstructured by Joan M. Gero, Possible Uses, Roles, and Meanings of Chavin-style Painted Textiles of South Coast Peru by Rebecca R. Stone, Megalithic Sites in the Nepena Valley, Peru by Richard E. Daggett, Huaca del Loro Revisited: The Nasca-Huarpa Connection by Allison C. Paulsen, Spatial Patterning and the Function of a Huari Architectural Compound by Christine C. Brewster-Wray, The Development of Huari Administrative Architecture by Lynda E. Spickard, Aspects of State Ideology in Huari and Tiwanaku Iconography: The Central Deity and the Sacrificer by Anita G. Cook, Shared Ideology and Parallel Political Development: Huari and Tiwanaku by William H. Isbell, Casma Incised Pottery: An Analysis of Collections from the Nepena Valley by Cheryl Daggett, High Altitude Land Use in the Huamachuco Area by T. McGreevy and R. Shaughnessy, La Lengua Pescadora: the Lost Dialect of Chimu Fishermen by Joel Rabinowitz, and The Chancas of Angaraes: 1450(?)--1765 by Paul H. Dillon.https://digitalcommons.library.umaine.edu/andean_past_special/1002/thumbnail.jp

Total Anomalous Pulmonary Venous Connection Morphology and Outcome From an International Population-Based Study

Background-Late mortality after repair of total anomalous pulmonary venous connection is frequently associated with pulmonary venous obstruction (PVO). We aimed to describe the morphological spectrum of total anomalous pulmonary venous connection and identify risk factors for death and postoperative PVO. Methods and Results-We conducted a retrospective, international, collaborative, population-based study involving all 19 pediatric cardiac centers in the United Kingdom, Ireland, and Sweden. All infants with total anomalous pulmonary venous connection born between 1998 and 2004 were identified. Cases with functionally univentricular circulations or atrial isomerism were excluded. All available data and imaging were reviewed. Of 422 live-born cases, 205 (48.6%) had supracardiac, 110 (26.1%) had infracardiac, 67 (15.9%) had cardiac, and 37 (8.8%) had mixed connections. There were 2 cases (0.5%) of common pulmonary vein atresia. Some patients had extremely hypoplastic veins or, rarely, discrete stenosis of the individual veins. Sixty (14.2%) had associated cardiac anomalies. Sixteen died before intervention. Three-year survival for surgically treated patients was 85.2% (95% confidence interval 81.3% to 88.4%). Risk factors for death in multivariable analysis comprised earlier age at surgery, hypoplastic/stenotic pulmonary veins, associated complex cardiac lesions, postoperative pulmonary hypertension, and postoperative PVO. Sixty (14.8%) of the 406 patients undergoing total anomalous pulmonary venous connection repair had postoperative PVO that required reintervention. Three-year survival after initial surgery for patients with postoperative PVO was 58.7% (95% confidence interval 46.2% to 69.2%). Risk factors for postoperative PVO comprised preoperative hypoplastic/stenotic pulmonary veins and absence of a common confluence. Conclusions-Preoperative clinical and morphological features are important risk factors for postoperative PVO and survival. (Circulation. 2010;122:2718-2726.