CASE REPORT Total Anomalous Pulmonary Venous Drainage Complicated by Tracheoesophageal Fistula Toru Okamura • Mitsugi Nagashima • Fumiaki Shikata • Takashi Higaki • Eiichi Yamamoto • Masaaki Ohta • Hidemi Takata Received: 7 March 2011 / Accepted: 17 May 2011 / Published online: 9 June 2011 Ó Springer Science+Business Media, LLC 2011 Abstract We provided emergency treatment to a 1-day- old neonate (1600 g) with tracheoesophageal fistula (gross classification, type C) and total anomalous pulmonary venous drainage (infracardiac type) complicated by pul- monary venous obstruction. Emergency surgery was required because the tracheoesophageal fistula would have caused respiratory failure. Here we report the perioperative management techniques we used, including the surgical strategy. Keywords Total anomalous pulmonary venous drainage Á Tracheoesophageal fistula Á Esophageal atresia Total anomalous pulmonary venous drainage (TAPVD) is an uncommon cardiac anomaly observed in 1.5–3.0% of cases of congenital heart disease (CHD) [2]. In addition, there have been only a few reports of its association with esophageal atresia (EA) [1, 3, 7]. We present the case of a patient with tracheoesophageal fistula (TEF) (esophageal atresia, gross type C) and TAPVD complicated by pul- monary venous obstruction (PVO). Case Report A female neonate weighing 1600 g was born after a cesarean section at 38 weeks’ gestation. She was diagnosed with Goldenhar’s syndrome. The 5-min Apgar score was 5, and she presented with cyanosis and respiratory failure. Echocardiogram showed TAPVD, and chest roentgeno- gram showed coil-up sign and pulmonary congestion. She was admitted to our hospital for medical treatment. Esophagus atresia (gross type C) was diagnosed on the basis of the coil-up sign and stomach gas. Chest roent- genogram taken on admission also showed severe pul- monary congestion and dextrocardia. Echocardiogram showed infracardiac-type TAPVD (Fig. 1a, b). An urgent surgery involving two-stage repair was planned for the TAPVD (infracardiac type) with PVO and EA (gross type C). TAPVD repair was performed after gastrostomy and insertion of a peritoneal dialysis catheter, which were per- formed to facilitate postoperative medical treatment and ventilation. Standard cardiopulmonary bypass (CPB) was performed, wherein the CPB was established at the ascending aorta and bicaval cannulations. After ligation of the patent ductus arteriosus, blood temperature was decreased to 20°C for dissection of the vertical vein. The vertical vein and common pulmonary chamber were dis- sected by carefully retracting the tiny heart. Cardioplegia was infused through the ascending aorta after cross-clamp- ing it, and the right atrium was opened. The point where the diaphragm was pierced was ligated with 6-0 Prolene suture. The vertical vein was divided and filleted proximally to the level of the superior pulmonary veins. The left atrium was opened obliquely as a suture line of the vertical vein through the posterior approach. Continuous anastomosis of the left atrium and vertical vein was performed by using 7-0 Prolene suture under low-flow bypass (10–20 ml kg -1 min -1 ). The T. Okamura (&) Á M. Nagashima Á F. Shikata Department of Cardiovascular Surgery, School of Medicine, Ehime University, Shitsukawa, Toon city, Ehime 791-0295, Japan e-mail: [email protected]T. Higaki Á E. Yamamoto Á M. Ohta Á H. Takata Department of Pediatrics, School of Medicine, Ehime University, Shitsukawa, Toon city, Ehime 791-0295, Japan 123 Pediatr Cardiol (2011) 32:983–985 DOI 10.1007/s00246-011-0011-z
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Total Anomalous Pulmonary Venous Drainage Complicated by ... · drainage Tracheoesophageal fistula Esophageal atresia Total anomalous pulmonary venous drainage (TAPVD) is an uncommon
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CASE REPORT
Total Anomalous Pulmonary Venous Drainage Complicatedby Tracheoesophageal Fistula
Toru Okamura • Mitsugi Nagashima •
Fumiaki Shikata • Takashi Higaki •
Eiichi Yamamoto • Masaaki Ohta • Hidemi Takata
Received: 7 March 2011 / Accepted: 17 May 2011 / Published online: 9 June 2011
� Springer Science+Business Media, LLC 2011
Abstract We provided emergency treatment to a 1-day-
old neonate (1600 g) with tracheoesophageal fistula (gross
classification, type C) and total anomalous pulmonary
venous drainage (infracardiac type) complicated by pul-
monary venous obstruction. Emergency surgery was
required because the tracheoesophageal fistula would have
caused respiratory failure. Here we report the perioperative
management techniques we used, including the surgical