Flashcards in this deck (34)

• What is the purpose of the incision in the posterior wall of the left atrium?

  To extend into the left atrial appendage for surgical management.
  surgery anatomy
• What suture is used for the direct anastomosis?

  Continuous absorbable Maxon suture.
  surgery suture
• What technique is used for small neonates during TAPVC surgery?

  Deep hypothermic circulatory arrest.
  surgery neonates
• What is used to direct the anomalous veins through the atrial septal defect?

  An autologous pericardial baffle.
  surgery anatomy
• What may be required if the right ventricle cannot generate high pressures after weaning from bypass?

  Extracorporeal membrane oxygenation may be necessary.
  surgery cardiology
• What should be maintained to minimize pulmonary resistance post-surgery?

  Ventilatory management and constant anesthesia.
  surgery intensive_care
• What is the target arterial PCO2 level after TAPVC surgery?

  Approximately 30 mmHg.
  surgery intensive_care
• What infusion may be continued for pulmonary vasodilatory effects?

  A low-dose isoproterenol infusion.
  surgery pharmacology
• What was the early mortality rate for TAPVC repair before 1970?

  Greater than 50%.
  surgery mortality
• What was the overall early mortality rate from 1980 to 2000 for TAPVC repair?

  17% (22 of 127 patients).
  surgery mortality
• What percentage of biventricular patients had pulmonary venous obstruction?

  55% (47 of 86 patients).
  surgery anatomy
• What factors were independent risk factors for early mortality?

  • Preoperative pulmonary venous obstruction (p = 0.008)
  • Single ventricle (p < 0.001)
  surgery risk_factors
• What was associated with post-repair pulmonary vein stenosis?

  The use of nonabsorbable suture (p = 0.005).
  surgery complications
• What was the overall hospital mortality rate for TAPVC between 1983 and 2001?

  14%
  health mortality
• How did hospital mortality change before and after 1995 for TAPVC?

  Decreased from 19% before 1995 to 5% after 1995
  health mortality
• What were significant predictors of overall health and school performance in TAPVC patients?

  Associated chromosomal or noncardiac syndromes, pulmonary venous obstruction
  health predictors
• What percentage of patients underwent emergency surgery due to pulmonary venous obstruction in the Bambino Gesu Hospital report?

  32%
  surgery obstruction
• What was the overall early mortality rate reported in the Bambino Gesu Hospital study?

  8%
  health mortality
• What was the Kaplan Meier survival rate at 18 years for patients in the Bambino Gesu Hospital study?

  88%
  survival health
• What was the freedom from reintervention rate for pulmonary venous obstruction at 18 years?

  87%
  surgery obstruction
• What predicted a higher risk of reintervention for pulmonary vein stenosis?

  Presence of preoperative obstruction (p = 0.02)
  surgery risk
• What was the overall early mortality rate for TAPVC patients in the Birmingham study?

  7%
  health mortality
• What was the incidence of pulmonary vein stenosis requiring intervention postoperatively in the Birmingham study?

  11%
  surgery stenosis
• What percentage of patients survived who had recurrent obstruction due to endocardial sclerosis?

  56%
  health prognosis
• What are independent risk factors for early and late mortality after surgery for pulmonary obstruction?

  • Small pulmonary confluence
  • Diffuse pulmonary vein stenosis
  surgery mortality pulmonary
• What was the early mortality rate reported by Korbmacher et al in their long-term follow-up study?

  35%
  mortality study follow-up
• How many significant arrhythmias were recorded in the long-term survivors in Korbmacher et al's study?

  11 of 24 cases
  arrhythmias study survivors
• What type of dysfunction was noted in three patients in Korbmacher et al's study?

  Sinus node dysfunction
  arrhythmias dysfunction study
• What was noted in nine cases among the long-term survivors in Korbmacher et al's study?

  Multiform ventricular ectopic beats
  arrhythmias ectopy study
• What was the conclusion regarding arrhythmias after repair of TAPVC according to the studies?

  Long-term follow-up of rhythm is important even in asymptomatic patients.
  tapvc arrhythmias follow-up
• What can develop if the vertical vein is not ligated according to Shah et al?

  An important left to right shunt
  vertical_vein shunt surgery
• What did Kumar et al find regarding the unligated vertical vein?

  It could be responsible for a left to right shunt.
  vertical_vein shunt surgery
• What do Kron and Cope suggest about leaving the vertical vein unligated?

  It may help allow right to left decompression during early hemodynamic instability.
  vertical_vein decompression surgery
• What was the general consensus on repairing TAPVC without cardiopulmonary bypass?

  Reports are sporadic and generally isolated cases.
  tapvc surgery bypass