The natural and surgically modified history of anomalous pulmonary veins from the left lung.
BACKGROUND
Reconstruction of anomalous left pulmonary veins (ALPV) requires an anastomosis at a nonanatomic position, posing the potential risk of pulmonary vein obstruction (PVO).


METHODS
The 514 patients who were diagnosed with a pulmonary vein abnormality from 1990 to 2010 were reviewed. Thirty-eight patients (7.4%; median age, 1.4 years; interquartile range, 0.1 to 5.7 years) were identified. ALPV was diagnosed as an isolated anomaly in 23 (61%) or as part of mixed total anomalous pulmonary venous drainage in 15 (39%). Patients were divided into 3 groups (group 1: partial ALPV, treated; group 2: total ALPV, treated; or group 3: partial ALPV, untreated). Freedom from poor clinical (death/reoperation) and functional (any PVO, mean pressure gradient > 3 mm Hg) outcomes were analyzed.


RESULTS
Repair in 30 ALPV patients (79%) was performed with direct anastomosis to the left atrium (n = 26 [68%]) or by sutureless repair (n = 4 [11%]). Two deaths occurred in group 2 (heart failure and PVO). The 4 reoperations in group 2 were prompted by PVO and occurred within 6 months of the initial repair. There was a nonsignificant trend of lower freedom from poor outcomes in group 2 (74.6%) vs group 1 (100%) at 10 years (p = 0.105). There was no difference in the incidence of any left PVO among the groups (p = 0.381). Severe left PVO did not develop in group 3 (n = 8 [21%]).


CONCLUSIONS
Total ALPV carries a high risk of early PVO. Thus, the optimal surgical approach remains elusive. Untreated partial ALPV remained unobstructed during midterm follow-up. Therefore, surgical treatment may not be necessary in patients with partial ALPV.
Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Yasuhiro
Y
Kotani
Devin
D
Chetan
Jiaquan
J
Zhu
Vijay
V
Anand
Christopher A
CA
Caldarone
Glen S
GS
Van Arsdell
John G
JG
Coles
Osami
O
Honjo
D000015:Abnormalities, Multiple / Q000601:surgery*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008168:Lung / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods
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