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J Thorac Cardiovasc Surg 2002;123:829
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Fate of the unligated vertical vein after surgical correction with total anomalous pulmonary venous connection in early infancy

University of Virginia School of Medicine, Department of Surgery, University of Virginia Medical Center, Charlottesville, VA 22908

To the Editor:

We read with interest the article titled "The Fate of the Unligated Vertical Vein After Surgical Correction of Total Anomalous Pulmonary Venous Connection in Early Infancy," by Kumar and colleagues, ¹ as well as the commentary by Spray. ² The authors referred to an article that our group published: "Is Vertical Vein Ligation Necessary in Repair of Total Anomalous Pulmonary Venous Connection?" ³ They discussed 4 of 10 patients at their institution undergoing repair of total anomalous pulmonary venous return in whom the vertical vein was not ligated. It subsequently stayed open in 3 of the 4 patients. In the first 3 patients, the vein was not originally ligated because of hemodynamic instability. The authors noted that 3 of 4 veins remained patent later but that in at least 1 of these situations there was a left atrial anastomotic stricture. The authors concluded that they did not support elective nonligation of the vertical vein. We believe their findings support our contention. They left the vein open originally because of difficulties weaning their patients from bypass. Subsequently, the vein stayed open only in the presence of residual pulmonary hypertension or late anastomotic stricture.

Spray's commentary was thought provoking. However, we do have a disagreement with him. He suggested, appropriately, that left-to-right shunting of the open vein would be poorly tolerated. However, in certain situations the patients seem to do better when the vein is left open. In those circumstances, we suspect that there is a right-to-left shunt resulting from postoperative pulmonary hypertension. The vein allows for shunting of right-sided blood to the left-sided chambers. As Spray stated, this is what occurs when a patent foramen ovale is left open because of a small right-sided stricture. Therefore, we believe there are circumstances in which the vein should be left open if hemodynamic instability is present after repair of obstructed total venous return done in early infancy.

12/8/121845

doi:10.1067/mtc.2002.121845

References

1. Kumar RNS, Dharmapuram AK, Rao IM, Gopalakrishnan VC, Pillai VR, Nazer YA, et al. The fate of the unligated vertical vein after surgical correction of total anomalous pulmonary venous connection in early infancy. J Thorac Cardiovasc Surg. 2001:122:615-7.
   
2. Spray TL. Commentary. J Thorac Cardiovasc Surg. 2001:122:617.
   
3. Cope JT, Banks D, McDaniel NC, Shockey KS, Nolan SP, Kron IL. Is vertical vein ligation necessary in repair of total anomalous pulmonary venous connection? Ann Thorac Surg. 1997;64:23-9.[Abstract/Free Full Text]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Irving L. Kron Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kron, I. L. Articles by Cope, J. T. Search for Related Content PubMed PubMed Citation Articles by Kron, I. L. Articles by Cope, J. T.