Surgery-related complications and their management in total anomalous pulmonary venous return during intensive care unit stay

Background: This study aims to evaluate complications that appear in patients with total anomalous pulmonary venous return (TAPVR) during intensive care period and preoperative and postoperative factors that affect them. Methods: The study included 31 TAPVR patients (21 males, 10 females; mean age 36 days; range 2 days to 6 months) operated in our clinic between January 2010 and May 2013. Patients with complex cardiac anomaly and single ventricle physiology were excluded. Patients' demographical characteristics, echocardiographic, angiographic and computed tomography angiographic, and any cardiac catheterization findings were evaluated. Duration and timing of operations, postoperative changes and complications such as pulmonary hypertensive crisis, arrhythmia, septicemia, and low cardiac output observed in intensive care unit were reviewed in detail. Results: Of patients with TAPVR, 58% were supracardiac, 19% were infracardiac, 13% were cardiac, and 10% were mixed type. Pulmonary venous obstruction was present in 10 patients (32%). While pulmonary hypertension crisis developed in eight patients (25%), low cardiac output was detected in six patients (19%). Rhythm problems were observed in 11 patients (35%). Pulmonary venous obstruction was more common in patients with infracardiac drainage TAPVR, low weight and small age (p<0.05). Five patients (16%) died during follow-up. Left ventricular hypoplasia, low cardiac output and preoperative asidosis were independent risk factors for mortality (p<0.05). Mean duration of follow-up was 15 months (3 months-2 years). During the follow-up, only one patient was reoperated for pulmonary venous obstruction. Conclusion: The mortality rate of TAPVR may decrease significantly with early diagnosis and effective, advanced, and suitable intensive care unit follow-up.