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J Thorac Cardiovasc Surg 1999;117:506-514
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

LONG-TERM OUTCOME OF INFANTS WITH SINGLE VENTRICLE AND TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

J. William Gaynor, MDa, Margaret H. Collins, MDb, Jack Rychik, MDc, John P. Gaughan, PhDd, Thomas L. Spray, MDa

From The Divisions of Cardiothoracic Surgery,a Pathology,b and Cardiology,c The Children's Hospital of Philadelphia, and the Department of Biostatistics,d Temple University School of Medicine, Philadelphia, Pa.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested June 10, 1998. Revisions received Oct 27, 1998. Accepted for publication Nov 3, 1998. Address for reprints: J. William Gaynor, MD, 34th St & Civic Center Blvd, Philadelphia, PA 19104.

Background and methods: Between January 1, 1984, and December 1, 1997, 73 infants with functional single ventricle and total anomalous pulmonary venous connection were admitted to our institution. A retrospective review was undertaken to determine factors influencing survival.
Results: Heterotaxy syndrome was present in 52 patients and hypoplastic left heart syndrome in 14. Obstructed total anomalous pulmonary venous connection was present in 21 patients. The pulmonary venous connection was supracardiac in 32 patients, cardiac in 21 patients, infracardiac in 13, and mixed in 7. Twelve patients died before the operation. The remaining 61 patients underwent surgery at a median age of 5 days (range 1 day–2.5 years). Overall survival was 45% at 6 months of age, 37% at 1 year, and 19% at 5 years. Survival for patients undergoing surgery was 54% at 6 months of age, 44% at 1 year, and 23% at 5 years. By univariate analysis with the Cox proportional hazards model, younger age at the time of the initial operation and repair of total anomalous pulmonary venous connection were predictors of mortality. Lung tissue from 14 patients was available for histologic examination. The pulmonary veins were dilated and wall thickness was increased. Increased muscularization of the arteries was seen in 11 patients.
Conclusions: The long-term prognosis for children undergoing staged reconstructive operations for single ventricle and total anomalous pulmonary venous connection is poor. Early mortality is high and late death is a continuing risk. Development of the pulmonary vasculature, especially the pulmonary veins, is abnormal, even in children without clinical evidence of pulmonary venous obstruction.






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