Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair?

Jiaquan Zhu, Yasuhiro Kotani, Devin Chetan, Lisa Zhao, John G. Coles, Christopher A. Caldarone, Glen S. Van Arsdell, Osami Honjo

Research output: Contribution to journalArticle

Abstract

Background The creation or enlargement of an atrial septal defect (ASD) in partial anomalous pulmonary venous drainage (PAPVD) repair may pose a risk of postoperative pulmonary vein stenosis (PVS), superior vena cava stenosis (SVCS), and atrial rhythm disturbances. Methods 155 children who underwent repair of right PAPVD between 1990 and 2010 were reviewed. PVS and SVCS were defined by mean gradients on echocardiography: mild = 3 to 5 mm Hg; severe = 6 mm Hg or higher. Postoperative cardiac rhythms were categorized as sinus, transient nonsinus, and persistent nonsinus rhythms. Outcomes were compared between patients who underwent the creation or superior enlargement of an ASD (group A) and those who did not (group B). Results There was no early or late death. Freedom from any PVS at 15 years after operation was lower in group A than in group B (76.1% vs 96.5%, p = 0.002), and no differences were found in freedom from severe PVS (p = 0.103), any SVCS (p = 0.419), or severe SVCS (p = 0.373). Group A patients had more PVS-related reoperations (p = 0.022). Nineteen patients had nonsinus rhythm, and 4 patients experienced first-degree atrioventricular block, but no significant difference was found between the groups. Cox regression revealed the creation or superior enlargement of an ASD as a predictor for postoperative PVS (p = 0.032). A case-match analysis confirmed a higher risk of PVS in patients with the creation or superior enlargement of an ASD (p = 0.018). Conclusions Late outcomes after repair of PAPVD are excellent. The subgroup that requires creation or superior enlargement of an ASD in repair of a right PAPVD is at a higher risk of late PVS and a subsequent increase in PVS-related reoperation. The presence of restrictive ASD did not increase SVCS, sinus node, or atrial conduction dysfunction.

Original languageEnglish
Pages (from-to)1664-1670
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number5
DOIs
Publication statusPublished - 2014
Externally publishedYes

Fingerprint

Atrial Heart Septal Defects
Drainage
Superior Vena Cava
Lung
Pathologic Constriction
Reoperation
Pulmonary Vein Stenosis
Sinoatrial Node
Atrioventricular Block
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair? / Zhu, Jiaquan; Kotani, Yasuhiro; Chetan, Devin; Zhao, Lisa; Coles, John G.; Caldarone, Christopher A.; Van Arsdell, Glen S.; Honjo, Osami.

In: Annals of Thoracic Surgery, Vol. 97, No. 5, 2014, p. 1664-1670.

Research output: Contribution to journalArticle

Zhu, J, Kotani, Y, Chetan, D, Zhao, L, Coles, JG, Caldarone, CA, Van Arsdell, GS & Honjo, O 2014, 'Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair?', Annals of Thoracic Surgery, vol. 97, no. 5, pp. 1664-1670. https://doi.org/10.1016/j.athoracsur.2014.01.051
Zhu, Jiaquan ; Kotani, Yasuhiro ; Chetan, Devin ; Zhao, Lisa ; Coles, John G. ; Caldarone, Christopher A. ; Van Arsdell, Glen S. ; Honjo, Osami. / Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair?. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 5. pp. 1664-1670.
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abstract = "Background The creation or enlargement of an atrial septal defect (ASD) in partial anomalous pulmonary venous drainage (PAPVD) repair may pose a risk of postoperative pulmonary vein stenosis (PVS), superior vena cava stenosis (SVCS), and atrial rhythm disturbances. Methods 155 children who underwent repair of right PAPVD between 1990 and 2010 were reviewed. PVS and SVCS were defined by mean gradients on echocardiography: mild = 3 to 5 mm Hg; severe = 6 mm Hg or higher. Postoperative cardiac rhythms were categorized as sinus, transient nonsinus, and persistent nonsinus rhythms. Outcomes were compared between patients who underwent the creation or superior enlargement of an ASD (group A) and those who did not (group B). Results There was no early or late death. Freedom from any PVS at 15 years after operation was lower in group A than in group B (76.1{\%} vs 96.5{\%}, p = 0.002), and no differences were found in freedom from severe PVS (p = 0.103), any SVCS (p = 0.419), or severe SVCS (p = 0.373). Group A patients had more PVS-related reoperations (p = 0.022). Nineteen patients had nonsinus rhythm, and 4 patients experienced first-degree atrioventricular block, but no significant difference was found between the groups. Cox regression revealed the creation or superior enlargement of an ASD as a predictor for postoperative PVS (p = 0.032). A case-match analysis confirmed a higher risk of PVS in patients with the creation or superior enlargement of an ASD (p = 0.018). Conclusions Late outcomes after repair of PAPVD are excellent. The subgroup that requires creation or superior enlargement of an ASD in repair of a right PAPVD is at a higher risk of late PVS and a subsequent increase in PVS-related reoperation. The presence of restrictive ASD did not increase SVCS, sinus node, or atrial conduction dysfunction.",
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T1 - Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair?

AU - Zhu, Jiaquan

AU - Kotani, Yasuhiro

AU - Chetan, Devin

AU - Zhao, Lisa

AU - Coles, John G.

AU - Caldarone, Christopher A.

AU - Van Arsdell, Glen S.

AU - Honjo, Osami

PY - 2014

Y1 - 2014

N2 - Background The creation or enlargement of an atrial septal defect (ASD) in partial anomalous pulmonary venous drainage (PAPVD) repair may pose a risk of postoperative pulmonary vein stenosis (PVS), superior vena cava stenosis (SVCS), and atrial rhythm disturbances. Methods 155 children who underwent repair of right PAPVD between 1990 and 2010 were reviewed. PVS and SVCS were defined by mean gradients on echocardiography: mild = 3 to 5 mm Hg; severe = 6 mm Hg or higher. Postoperative cardiac rhythms were categorized as sinus, transient nonsinus, and persistent nonsinus rhythms. Outcomes were compared between patients who underwent the creation or superior enlargement of an ASD (group A) and those who did not (group B). Results There was no early or late death. Freedom from any PVS at 15 years after operation was lower in group A than in group B (76.1% vs 96.5%, p = 0.002), and no differences were found in freedom from severe PVS (p = 0.103), any SVCS (p = 0.419), or severe SVCS (p = 0.373). Group A patients had more PVS-related reoperations (p = 0.022). Nineteen patients had nonsinus rhythm, and 4 patients experienced first-degree atrioventricular block, but no significant difference was found between the groups. Cox regression revealed the creation or superior enlargement of an ASD as a predictor for postoperative PVS (p = 0.032). A case-match analysis confirmed a higher risk of PVS in patients with the creation or superior enlargement of an ASD (p = 0.018). Conclusions Late outcomes after repair of PAPVD are excellent. The subgroup that requires creation or superior enlargement of an ASD in repair of a right PAPVD is at a higher risk of late PVS and a subsequent increase in PVS-related reoperation. The presence of restrictive ASD did not increase SVCS, sinus node, or atrial conduction dysfunction.

AB - Background The creation or enlargement of an atrial septal defect (ASD) in partial anomalous pulmonary venous drainage (PAPVD) repair may pose a risk of postoperative pulmonary vein stenosis (PVS), superior vena cava stenosis (SVCS), and atrial rhythm disturbances. Methods 155 children who underwent repair of right PAPVD between 1990 and 2010 were reviewed. PVS and SVCS were defined by mean gradients on echocardiography: mild = 3 to 5 mm Hg; severe = 6 mm Hg or higher. Postoperative cardiac rhythms were categorized as sinus, transient nonsinus, and persistent nonsinus rhythms. Outcomes were compared between patients who underwent the creation or superior enlargement of an ASD (group A) and those who did not (group B). Results There was no early or late death. Freedom from any PVS at 15 years after operation was lower in group A than in group B (76.1% vs 96.5%, p = 0.002), and no differences were found in freedom from severe PVS (p = 0.103), any SVCS (p = 0.419), or severe SVCS (p = 0.373). Group A patients had more PVS-related reoperations (p = 0.022). Nineteen patients had nonsinus rhythm, and 4 patients experienced first-degree atrioventricular block, but no significant difference was found between the groups. Cox regression revealed the creation or superior enlargement of an ASD as a predictor for postoperative PVS (p = 0.032). A case-match analysis confirmed a higher risk of PVS in patients with the creation or superior enlargement of an ASD (p = 0.018). Conclusions Late outcomes after repair of PAPVD are excellent. The subgroup that requires creation or superior enlargement of an ASD in repair of a right PAPVD is at a higher risk of late PVS and a subsequent increase in PVS-related reoperation. The presence of restrictive ASD did not increase SVCS, sinus node, or atrial conduction dysfunction.

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