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Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients  Yasuhiro Kotani,

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Presentation on theme: "Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients  Yasuhiro Kotani,"— Presentation transcript:

1 Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients  Yasuhiro Kotani, MD, PhD, Jiaquan Zhu, MD, PhD, Lars Grosse-Wortmann, MD, Osami Honjo, MD, PhD, John G. Coles, MD, Glen S. Van Arsdell, MD, Christopher A. Caldarone, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 149, Issue 5, Pages (May 2015) DOI: /j.jtcvs Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Hypothesis of anatomic factor contributing left-sided pulmonary vein obstruction. Arrow shows narrowed left pulmonary vein between the heart and descending aorta. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Measurement of intrathoracic structures by cardiac magnetic resonance. Axial slice at the level of left lower pulmonary vein was chosen from cardiac magnetic resonance. All measurement was normalized by thoracic dimension. Antero-posterior dimension: (posterior sternal plate to anterior margin of vertebra)/(posterior sternal plate to posterior margin of the lungs). Horizontal dimension: (maximum horizontal dimension of thoracic cavity)/(posterior sternal plate to posterior margin of the lungs). Distance from vertebra to aorta: distance from anterior margin of vertebra to center of descending aorta normalized by using vertical and horizontal dimension of thoracic cavity. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Left lower pulmonary vein before and after sutureless repair. A, Before sutureless repair, the left lower PV is narrowed by compression of the heart and descending aorta. B, After sutureless repair, the confluence of the left lower PV to the atrium is well augmented. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Relationship between clinical outcomes and anatomic characteristics. Patients with left-sided PVO (circle) had more cardiomegaly and antero-laterally located descending aorta compared with patient without PVO (diamond). Cardiomegaly was associated with failed Fontan completion (closed diamond). PVO, Pulmonary vein obstruction. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

6 Combination of cardiomegaly and antero-latellary located descending aorta is a risk for left PVO.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions


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