“Hemodynamic rehabilitation” of the left ventricleat early time after surgical correction of total anomalouspulmonary venous connection in children

Authors: Morozov A.A.1, Movsesyan R.R.2, 3, Fedorova N.V.2, Golubeva M.V.2, Vasichkina E.S.1

Company: 1 Almazov National Medical Research Centre of Ministry of Health of the Russian Federation, ulitsa Akkuratova, 2, Saint-Petersburg, 197341, Russian Federation;
2 Children's City Hospital # 1, ulitsa Avangardnaya, 14, Saint-Petersburg, 198205, Russian Federation;
3 North-Western State Medical University named after I.I. Mechnikov of Ministry of Health of the Russian Federation, ulitsa Kirochnaya, 41, Saint-Petersburg, 191015, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2019-13-4-320-327

For citation: Morozov A.A., Movsesyan R.R., Fedorova N.V., Golubeva M.V., Vasichkina E.S. “Hemodynamic rehabilitation” of the left ventricle at early time after surgical correction of total anomalous pulmonary venous connection in children. Creative Cardiology. 2019; 13 (4): 320–7 (in Russ.). DOI: 10.24022/ 1997-3187-2019-13-4-320-327

Received / Accepted:  03.12.2019/16.12.2019

Keywords: total anomalous pulmonary venous connection left ventricle

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Abstract

Introduction. The patients with total anomalous pulmonary venous connection have no direct connection between pulmonary veins and left atrium. Atrial septal defect is a source of left cardiac chambers filling and stroke volume. There is an initial decrease of the left ventricle (LV) due to pressure and volume overload of the right heart and the restriction on atrial septal defect (ASD). The assessment of the LV to restore of its size and volume after surgical correction is an actual problem of total anomalous pulmonary venous connection (TAPVC) surgery.

Material and methods. There were included 36 patients with TAPVC. The median age of the patients was 37.5 d.o. [13; 104] and body weight 4.5 kg [3.5; 5]. All patients have been examined by transthoracic echocardiography with measurement of mitral valve (MV) size, ASD, the calculation of LV end-diastolic size Z-score (EDS) and LV enddiastolic volume index (EDVi) before and after surgery. In patients with available preoperative CT-angiography, measurements of ventricular dimension and its ratio were calculated.

Results. The supracardiac type of TAPVC was identified in 19 (52.8%) patients, cardiac type – 11 (30.6%), infracardiac – 3 (8.3%) and mix type – in 3 (8.3%) patients. The preoperative MV size was 12 mm [9.7; 12.5], Z-score MV was –0.15 [–1.03; 1.02], ASD 6 mm [–5; 8], LV EDS Z-score was –3.4 [–4.25; –2.74], LV EDVi was 23.3 ml/m2 [18.7; 30.3], left ventricle and right ratio was 0.67 [0.53; 0.8]. After surgery the LV EDS Z-score increased to –0.91 [–1.61; –0.31], LV EDVi to 50.9 ml/m2 [42.9; 55.8].

Conclusion. Despite an initial decrease of LV, elimination of the compression and creation of the adequate preload provide “hemodynamic rehabilitation” of the LV with normalization of the ventricle dimension at early postoperative time.

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About Authors

  • Aleksandr A. Morozov, Cand. Med. Sc., Senior Researcher, Cardiac Surgeon, ORCID;
  • Ruben R. Movsesyan, Dr. Med. Sc., Professor, Corresponding Member of Russian Academy of Sciences, Head of Department, Professor, ORCID;
  • Natal’ya V. Fedorova, Cardiologist, ORCID;
  • Mariya V. Golubeva, Head of Department, ORCID;
  • Elena S. Vasichkina, Dr. Med. Sc., Chief Researcher, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery