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A suggested new surgical classification for mixed totally anomalous pulmonary venous connection

Published online by Cambridge University Press:  25 June 2007

Ujjwal K. Chowdhury*
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Amber Malhotra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Shyam S. Kothari
Affiliation:
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Sri Krishna Reddy
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Anand K. Mishra
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Kizakke K. Pradeep
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Panangipalli Venugopal
Affiliation:
Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Dr Ujjwal K. Chowdhury, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. Tel: +91 11 26588700, 91 11 26588500 Ext. 4835; Fax: +91 11 26588663, 26588641 E-mails: ujjwalchow@rediffmail.com, ujjwalchowdhury@gmail.com

Abstract

The morphologic variations of mixed totally anomalous pulmonary venous connection are many and varied. In this review, we give an account of all cases previously described as mixed totally anomalous pulmonary venous connection, analyzing in detail those cases where an accurate anatomical description was provided. We identified 182 suitable cases, from 54 investigations, and reviewed the clinical presentation, anatomic variations, diagnostic features, and management of the patients described.

Cross-sectional echocardiography, and cardiac catheterization, provided the necessary diagnostic information, and defined the anatomy before surgery in 139 patients. Magnetic resonance imaging and computerized tomographic angiography had been used for further clarification of the pulmonary venous anatomy. An obstructive pattern of drainage, involving one or more pulmonary veins, had been described in over half of the patients. We then grouped the lesions into categories that have a bearing on the appropriate surgical approach, discussing the appropriate repair for each group. For the overall group, the operative mortality remains high, at 22.9%. We submit that an increased appreciation of various types of mixed totally anomalous pulmonary venous connection may well contribute to improved future surgical management.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2007

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