Research Article
The Unligated Vertical Vein in Obstructive Supracardiac Totally Anomalous Pulmonary Venous Connection: Concept, Concerns and Future Directions
Ujjwal K Chowdhury*, Lakshmi Kumari Sankhyan, Niwin George, Sukhjeet Singh, Abhinav Singh Chauhan, Priya Jagia, Vishwas Malik, Suruchi Hasija and Vasubabu Gudala
Corresponding Author: Dr. Ujjwal Kumar Chowdhury, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
Received: April 09, 2019; Accepted: April 25, 2019; Published: August 13, 2019;
Citation: Chowdhury UK, Sankhyan LK, George N, Singh S, Chauhan AS, et al. (2019) The Unligated Vertical Vein in Obstructive Supracardiac Totally Anomalous Pulmonary Venous Connection: Concept, Concerns and Future Directions. J Cardiol Diagn Res, 2(2): 94-108.
Copyrights: ©2019 Chowdhury UK, Sankhyan LK, George N, Singh S, Chauhan AS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

The present perspective is a synthesis of 75 published investigations in the setting of rechanneling of supracardiac totally anomalous pulmonary venous connection with or without vertical vein ligation in the literature. In this article, we review the issue of unligated/ligated vertical vein, adjustable vertical vein ligature, routine left atrial augmentation and atrial septal fenestration after rechanneling of supracardiac totally anomalous pulmonary venous connection in order to decrease perioperative pulmonary hypertensive crises, postoperative low cardiac output syndrome and mortality. Additionally, this review attempts to address the guidelines for selective vertical vein patency in patients with obstructive supracardiac totally anomalous pulmonary venous connection.

 

Keywords: Vertical vein, Totally anomalous pulmonary venous connection, Pulmonary hypertensive crises, Adjustable vertical vein ligature

INTRODUCTION

Reports addressing the issue of not ligating the vertical vein following repair of totally anomalous pulmonary venous connection, and related postoperative hemodynamics are limited and conflicting [1-11]. Traditionally, ligation of the vertical vein at the time of rechanneling of totally anomalous pulmonary venous connection has been recommended to prevent the perceived consequences of a residual left-to-right shunt [1-11]. Some investigators have expressed concern about the occurrence of acute hepatic necrosis following ligation of the vertical vein [12]. This concept was so ingrained in the practice of rechanneling of totally anomalous pulmonary venous connection that five major anatomical and pathophysiological issues of obstructive totally anomalous pulmonary venous connection were either not well appreciated or ignored.

The first is the issue of varying reports of left heart volume characteristics in obstructive totally anomalous pulmonary venous connection from normal findings to the conclusion that the left sided chambers are smaller than normal and the left atrium lacks both normal compliance and reservoir function [13-22]. Such chamber abnormalities have been attributed to large left-to-right shunt causing reduced atrial filling and decreased left ventricular relax