Predicting the Need for Pulmonary Venous Reintervention in Total Anomalous Pulmonary Venous Connection: The Role of Preoperative Echocardiographic Metrics

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-03-06 DOI:10.1111/echo.70124

Helen M. Stanley, Jennifer A. Faerber, Meryl S. Cohen, Ryan Callahan, Stephanie M. Fuller, Brian R. White

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引用次数: 0

Abstract

Purpose

Development of postoperative obstruction in total anomalous pulmonary venous connection (TAPVC) is a major cause of morbidity and mortality. Although preoperative echocardiography has often been cited as prognostic of postoperative outcome, its predictive value has not been fully evaluated. Pulmonary venous variability index (PVVI) is an echocardiographic metric developed at our center and previously shown to correlate with preoperative clinical markers and catheterization findings of obstruction. We hypothesized that preoperative PVVI would be superior to maximum and mean velocity for prediction of postsurgical outcome in TAPVC.

Methods

We performed a retrospective review of TAPVC patients repaired at our center. Preoperative echocardiograms were reviewed for clinical read, and measures of pulmonary venous obstruction including maximum, mean, and minimum velocity and PVVI ([maximum velocity−minimum velocity]/mean velocity) were calculated from spectral Doppler of the pulmonary venous pathway. The outcome was time to surgical or catheter-based pulmonary vein reintervention.

Results

In total, 162 patients were included and 33 (20%) underwent reintervention. On univariate Cox proportional hazards model, single ventricle status, mixed-type TAPVC, and PVVI ≤ 0.5 were predictive of reintervention (hazard ratios of 2.7, p = 0.01; 3.2, p = 0.01; and 2.2, p = 0.03, respectively). Absolute echocardiographic velocities were not associated with the outcome. On multivariate analysis, single ventricle status and mixed-type TAPVC remained significant predictors of reintervention, while PVVI did not.

Conclusions

Though preoperative PVVI was associated with an increased risk of postoperative reintervention in TAPVC by univariate analysis, multivariate analysis suggests that single ventricle status and TAPVC subtype are the strongest drivers of postoperative outcomes. Preoperative velocities are not predictive of outcome in TAPVC.

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预测完全异常肺静脉连接的肺静脉再干预的需要：术前超声心动图指标的作用

目的全异常肺静脉连接（TAPVC）术后梗阻的发生是导致发病率和死亡率的主要原因。虽然术前超声心动图经常被引用作为术后预后的预测指标，但其预测价值尚未得到充分评估。肺静脉变异性指数（PVVI）是我们中心开发的超声心动图指标，先前显示与术前临床指标和导管阻塞相关。我们假设术前PVVI优于最大流速和平均流速来预测TAPVC的术后预后。方法我们对在本中心进行TAPVC修复的患者进行回顾性分析。回顾术前超声心动图以供临床阅读，并根据肺静脉通路的频谱多普勒计算肺静脉阻塞的测量指标，包括最大、平均、最小流速和PVVI（[最大流速-最小流速]/平均流速）。结果是手术或导管为基础的肺静脉再干预的时间。结果共纳入162例患者，其中33例（20%）进行了再干预。在单因素Cox比例风险模型中，单心室状态、混合型TAPVC和PVVI≤0.5是再干预的预测因素(风险比为2.7,p = 0.01；3.2, p = 0.01；和2.2,p = 0.03)。绝对超声心动图速度与结果无关。在多变量分析中，单心室状态和混合型TAPVC仍然是再干预的显著预测因子，而PVVI则没有。结论单因素分析显示术前PVVI与TAPVC术后再干预风险增加相关，但多因素分析表明，单心室状态和TAPVC亚型是影响术后预后的最重要因素。术前速度不能预测TAPVC的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.