The Use of Minimally Invasive Surgical Techniques in Pediatric Patients with Partial Anomalous Pulmonary Venous Return

Year 2024, , 519 - 524, 31.08.2024

Mustafa Yılmaz , Başak Soran Türkcan , Ata Niyazi Ecevit , Yasemin Özdemir Şahan , Alper Gürsu , Atakan Atalay

https://doi.org/10.54005/geneltip.1464770

Abstract

Aim: The use of minimally invasive procedures in low-risk congenital heart surgeries has been increasing recently. Compared to traditional median sternotomy, minimally invasive techniques offer better cosmetic results and provide more satisfaction to both the patient and their parents. Partial anomalous pulmonary venous return (PAPVR) can be safely repaired using these techniques.
Material and Metods: The perioperative data of right- sided PAPVR patients who were operated on using minimally invasive approaches in our clinic between March 2019 and January 2023 were reviewed retrospectively. The perioperative data of the patients' including , type of surgery , cardiopulmonary bypass time, cross-clamp time, postoperative cardiac rhythm, total operation time, total drainage, total intensive care unit time, and total hospital stay time were obtained. The results were compared with the data in the current literature.
Results: During the study period, 14 patients underwent surgical repair. Five (36%) of them were female and nine (64%) were male. Patients undergoing right infraaxillary vertical thoracotomy (RIAVT) and right anterolateral thoracotomy (RALT) had mean ages of 48±26.6 and 42±18.2 month, respectively. High venosum type atrial septal defect (ASD) was detected in 12 (85.7%) of the patients. The most frequently used surgical treatment was the double patch technique which was used in 12 patients (85.7%). This was followed by single patch repair with one patient (7.1 %). The Warden procedure was used in one patient (7.1%) who was operated on with the RIAVT technique. Patients’ cross-clamp, cardiopulmonary bypass (CPB), and total operation times were comparable to those reported in the medical literature.
Conclusion: RIAVT and RALT are two of the oftenly used minimally invasive surgical techniques in congenital heart surgery. After gaining sufficient experience, both of these methods can be safely applied to PAPVR repair.

Keywords

Anomalous pulmonary venous return, pediatrics, minimally invasive surgical procedure, thoracotomy

Parsiyel Anormal Pulmoner Venöz Dönüş Anomalili Pediatrik Hastalarda Minimal İnvaziv Cerrahi Tekniklerin Kullanımı

Abstract

Amaç: Son zamanlarda, düşük riskli doğumsal kalp cerrahisinde minimal invaziv prosedürlerin kullanımı artmaktadır. Geleneksel median sternotomiye kıyasla minimal invaziv teknikler daha iyi kozmetik sonuçlar sunmakta ve hem hastaya hem de ebeveynlerine daha fazla memnuniyet sağlamaktadır. Pediatrik Hastalarda , parsiyel anormal pulmoner venöz dönüş anomalisi (PAPVD) , bu teknikler kullanılarak güvenle onarılabilmektedir.
Gereç ve Yöntem: Mart 2019 ile Ocak 2023 tarihleri arasında kliniğimizde minimal invaziv yaklaşımlar kullanılarak ameliyat edilen sağ taraflı PAPVD anomalili hastalarının perioperatif verileri retrospektif olarak incelendi. Hastaların perioperatif verileri çerçevesinde , uygulanan cerrahi tipleri, kardiopulmoner bypass süreleri, kross klemp süreleri, postoperatif kardiyak ritimleri , toplam operasyon süreleri, toplam drenajları, toplam yoğun bakım süreleri , toplam hastanede kalış süreleri ve mortalite verileri toplandı. Sonuçlar mevcut literatürdeki verilerle karşılaştırıldı.
Bulgular: Çalışma döneminde 14 hasta opera edildi . Bunların beşi (%36) kadın ve dokuzu (%64) erkekti. Sağ infraaksiller vertikal torakotomi(SIAVT) ve sağ anterolateral torakotomi(SALT) yapılan hastaların yaş ortalamaları sırasıyla 48±26,6 ve 42±18,2 aydı. Hastaların 12'sinde (%85,7) yüksek venöz tip atriyal septal defekt tespit edildi. En sık kullanılan cerrahi tedavi çift yama tekniği olup, bu yöntem 12 hastada (%85,7) kullanıldı. Bunu, bir hastada (%7,1) tek yama onarımı izledi. SIAVT tekniği ile ameliyat edilen bir hastada (%7,1) Warden prosedürü uygulandı. Hastaların kross klemp , kardiopulmoner bypass ve toplam operasyon süreleri, tıbbi literatürde bildirilenlerle benzer olarak izlendi.
Sonuç: SIAVT ve SALT , konjenital kalp cerrahisinde sıkça kullanılan minimal invaziv cerrahi tekniklerdir. Yeterli deneyim kazandıktan sonra, bu yöntemlerin her ikisi de PAPVD onarımında güvenle uygulanabilir.

Keywords

Anormal pulmoner venöz dönüş, pediatri, minimal invaziv cerrahi prosedür, torakotomi

References

• Healey Jr JE. An anatomic survey of anomalous pulmonary veins: their clinical significance. J Thorac Surg 1952;23: 433-44.
• Alsoufi B, Cai S, Van Arsdell GS, Williams WG, Caldarone CA, Coles JG. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. Ann Thorac Surg 2007; 84 :2020-6.
• Gustafson RA, Warden HE, Murray GF. Partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 1995;60: 614-617.
• Senocak F, Ozme S, Bilgiç A, Ozkutlu S, Ozer S, Saraçlar M. Partial anomalous pulmonary venous return. Evaluation of 51 cases. Jpn Heart J 1994;35: 43-50.
• Ammash NM, Seward JB, Warnes CA, Connolly HM, O’Leary PW, Danielson GK. Partial anomalous pulmonary venous connection: diagnosis by transesophageal echocardiography. J Am Coll Cardiol 1997;29: 1351-8.
• An K, Li S, Yan J, Wang X, Hua Z. Minimal right vertical infra-axillary incision for repair of congenital heart defects. Ann Thorac Surg 2022;113: 896-902.
• Rao RK, Varadaraju R, Basappa G, Nagaraja P. Repair of sinus venosus defects with partial anomalous pulmonary venous connection in children by modified right vertical infra axillary thoracotomy. Innovations 2019;14: 553-7.
• Zubritskiy A, Arkhipov A, Khapaev T, Naberukhin Y, Omelchenko A, Gorbatykh Y, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg 2016;22: 225-7.
• Kasahara H, Aeba R, Tanami Y, Yozu R. Multislice computed tomography is useful for evaluating partial anomalous pulmonary venous connection. J Cardiothorac Surg 2010;5: 1-3.
• Amirghofran AA, Nirooei E, Edraki M, Ramsheh AR, Ajami G, Amoozgar H, et al. Minimally invasive versus sternotomy approach for double‐patch repair of partial anomalous pulmonary venous connection and sinus venosus defect in pediatric and adult patients: Mid to long‐term outcomes. J Thorac Surg 2022;37:4808-15.
• Buz S, Alexi-Meskishvili V, Villavicencio-Lorini F, Yigitbasi M, Hübler M, Weng Y, et al. Analysis of arrhythmias after correction of partial anomalous pulmonary venous connection. Ann Thorac Surg 2009;87: 580-3.
• DiBardino DJ, McKenzie ED, Heinle JS, Su JT, Fraser CD. The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein. Cardiol Young 2004;14:64-7.
• Stewart RD, Bailliard F, Kelle AM, Backer CL, Young L, Mavroudis C. Evolving surgical strategy for sinus venosus atrial septal defect: effect on sinus node function and late venous obstruction. Ann Thorac Surg 2007;84: 1651-5.
• Park CS, Kwak JG, Lee C, Lee C-H, Lee SY, Choi EY, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg 2012;41:261-5.
• Shahriari A, Rodefeld MD, Turrentine MW, Brown JW. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg 2006;81: 224-30.
• Okonta KE, Agarwal V. Does Warden's procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection? Interact Cardiovasc Thorac Surg 2012;14:839-42.
• Griffeth EM, Dearani JA, Mathew J, Graham GC, Connolly HM, King KS, et al. Early and Late Outcomes of the Warden and Modified Warden Procedure. Ann Thorac Surg 2022; 114: 1723-1729
• Yong MS, Griffiths S, Robertson T, Brink J, d’Udekem Y, Brizard C, et al. Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children. Interact Cardiovasc Thorac Surg 2018;27 :422-6.