“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

For correspondence:  Sign in or register.

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

Subscribe 🔒



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.


  1. Liufu R., Shi G., Zhu F., Guan Y., Lu Z., Chen W. et al. Superior approach for supracardiac total anomalous pulmonary venous connection. Ann. Thorac. Surg. 2018; 105: 1429–35
  2. Kirklin J.W., Barratt-Boyes B.G. Total anomalous pulmonary venous connection. In: Kirklin/Barratt-Boyes cardiac surgery. New York: John Wiley and Sons; 1986: 499–523
  3. Whight C.M., Barratt-Boyes B.G., Calder A.L., Neutze J.W., Brandt P.W.T. Total anomalous pulmonary venous connection. Long-term results following repair in infancy. J. Thorac. Cardiovasc. Surg. 1978; 75: 52–63
  4. Goor D.A., Yellin A., Frand M., Smolinsky A., Neufeldt S. The operative problem of small left atrium in total anomalous pulmonary venous connection. Report of 5 patients. Ann. Thorac. Surg. 1976; 22: 245–8. DOI: 10.1016/s0003-4975(10)64910-7
  5. Corno A., Giamberti A., Carotti A., Giannico S., Marino B., Marcelletti C. Total anomalous pulmonary venous connection: surgical repair with a double-patch technique. Ann. Thorac. Surg. 1990; 49 (3): 492–4. DOI: 10.1016/0003-4975(90)90270-g
  6. Michielon G., Di Donato R.M., Pasquini L., Giannico S., Brancaccio G., Mazzera E. et al. Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions. Eur. J. Cardiothorac. Surg. 2002; 22 (2): 184–91. DOI: 10.1016/s1010-7940(02)00247-6
  7. Mathew R., Thilenius O.G., Replogle R.L., Arcilla R.A. Cardiac function in total anomalous pulmonary venous return before and after surgery. Circulation. 1977; 55: 361–70. DOI: 10.1161/01.cir.55.2.361
  8. Yanagawa B., Alghamdi A.A., Dragulescu A., Viola N., Al-Radi O.O., Mertens L.L. et al. Primary sutureless repair for “simple” total anomalous pulmonary venous connection: midterm results in a single institution. J. Thorac. Cardiovasc. Surg. 2011; 141 (6): 1346–54. DOI: 10.1016/j.jtcvs.2010.10.056
  9. Corno A.F. Borderline left ventricle. Eur. J. Cardiothorac. Surg. 2005; 27 (1): 67–73. DOI: 10.1016/j.ejcts.2004.10.034
  10. Hammon J.W., Lupinetti F.M., Maples M.D., Merrill W.H., First W.H., Graham T.P., Jr. et al. Predictors of operative mortality in critical valvular aortic stenosis presenting in infancy. Ann. Thorac. Surg. 1988; 45: 537–40. DOI: 10.1016/S0003-4975(10)64527-4
  11. Parsons M.K., Moreau G.A., Graham T.P., Johns J.A., Boucek R.J. Echocardiographic estimation of critical left ventricular size in infants with isolated aortic valve stenosis. J. Am. Coll. Cardiol. 1991; 18: 1049–55. DOI: 10.1016/0735-1097(91)90765-2
  12. Oliveira L.C., Valdez-Cruz L.M., Allen H.D., Horowitz S., Sahn D.J., Goldberg S.J. et al. Prognostic value of left ventricular size measured by echocardiography in infants with total anomalous pulmonary venous drainage. Am. J. Cardiol. 1983; 51: 1155–9. DOI: 10.1016/0002-9149(83)90362-4
  13. Misumi H., Imai Y., Ishihara K. Hoshino S., Sawatari K., Seo K. et al. Pre and postoperative left ventricular volume and function in infants and children with total anomalous pulmonary venous return. Kyobugeka. Jap. J. Thorac. Surg. 1993; 46 (11): 926–30
  14. Phoon C.K., Silverman N.H. Conditions with right ventricular pressure and volume overload and a small left ventricle: “hypoplastic” left ventricle or simply a squashed ventricle? J. Am. Coll. Cardiol. 1997; 30: 1547–53. DOI: 10.1016/S0735-1097(97)00351-3
  15. Bove K.E., Geiser E.A., Meyer R.A. The left ventricle in anomalous pulmonary venous return: morphometric analysis of 36 fatal cases in infancy. Arch. Pathol. 1975; 99: 522–8
  16. Rosenquist G.C., Kelly J.L., Chandra R., Ruckman R.N., Galioto F.M., Jr., Midgley F.M. et al. Small left atrium and change in contour of the ventricular septum in total anomalous pulmonary venous connection: a morphometric analysis of 22 infant hearts. Am. J. Cardiol. 1985; 55 (6): 777–82. DOI: 10.1016/0002-9149(85)90155-9
  17. Katz N.M., Kirklin J.W., Pacifico A.D. Concepts and practices in surgery for total anomalous pulmonary venous connection. Ann. Thorac. Surg. 1978; 25: 479–87. DOI: 10.1016/S0003-4975(10)63593-X
  18. Kumar R.N.S., Dharmapuram A.K., Rao I.M., Gopalakrishnan V.C., Pillai V.R., Nazer Y.A. et al. The fate of the unligated vertical vein after surgical correction of total anomalous pulmonary venous connection in early infancy. J. Thorac. Cardiovac. Surg. 2001; 122: 615–17. DOI: 10.1067/mtc.2001.114097
  19. Caspi J., Pettitt T.W., Fontenot E.E., Stopa A.R., Heck H.A., Munfakh N.A. et al. The beneficial hemodynamic effects of selective patent vertical vein following repair of obstructed total anomalous pulmonary venous drainage in infants. Eur. J. Cardiothorac. Surg. 2001; 20 (4): 830–4. DOI: 10.1016/s1010–7940(01)00898-3
  20. Shah M.J., Shah S., Shankargowda S., Krishnan U., Cherian K.M. LR Shunt: A serious consequence of tapvc repair without ligation of vertical vein. Ann. Thorac. Surg. 2000; 70 (3): 971–3. DOI: 10.1016/S0003-4975(00)01406-5

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