Patients with a "2+2" pattern of mixed totally anomalous pulmonary venous connection constitute the safe anatomic category for rechanneling, followed by the "3+1" variety. Cross-sectional echocardiography and/or computed tomographic angiography are mandatory to provide necessary diagnostic information and define the anatomy. Patients aged 2 months or younger, obstructive totally anomalous pulmonary venous connection, and perioperative pulmonary hypertensive crises were significant risk factors for death by logistic regression analysis. The risk of death was 5.85 times higher (95% confidence interval: 1.46-35.68; P = .02) in patients with category III of mixed TAPVC. The precise technique adopted in an individual patient depends on the pattern of anatomic drainage, and an individualized surgical approach is recommended.
ObjectiveThe study aimed to identify the factors affecting the prognosis of post
myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a
protocol for its management.MethodsThis was a single center, retrospective-prospective study (2009-2014),
involving 55 patients with post MI VSR. The strengths of association between
risk factors and prognosis were assessed using multivariate logistic
regression analysis. The UNM Post MI VSR management and prognosis scoring
systems (UPMS & UPPS) were developed.ResultsThirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%)
patients underwent concomitant coronary artery bypass grafting. Residual
ventricular septal defect was found in 3 (7.5%) patients. The multivariate
analysis showed low mean blood pressure with intra-aortic balloon pump (OR
11.43, P=0.001), higher EuroSCORE II (OR 7.47,
P=0.006), higher Killip class (OR 27.95,
P=0.00), and shorter intervals between MI and VSR (OR
7.90, P=0.005) as well as VSR and Surgery (OR 5.76,
P=0.016) to be strong predictors of mortality.
Concomitant coronary artery bypass grafting (P=0.17) and
location (P=0.25) of VSR did not affect the outcome. Mean
follow-up was 635.8±472.5 days and 17 out of 19 discharged patients
were in NYHA class I-II.ConclusionThe UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and
prognosis, respectively. They divide patients into 3 groups: 1) Immediate
Surgery - Patients with scores of <25 require immediate surgery,
preferably with extracorporeal membrane oxygenation support, and have poor
prognosis; 2) Those with scores of 25-75 should be managed with "Optimal
Delay" and they have intermediate outcomes; 3) Patients with scores of
>75 can undergo Elective Repair and they are likely to have good
outcomes.
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