Percutaneous Embolization of No Ligated Vertical Veins After Total Anomalous Pulmonary Vein Return Operation and Risk Factors for Its Persistence.

Background: The vertical vein (VV) ligation during the total anomalous pulmonary venous return (TAPVR) correction is still controversial. Our study aimed to define the potential risk factors for VV persistence and their percutaneous occlusion.

Methods: The retrospective cohort study included 40 patients (26 males) with TAPVR treated at the tertiary referral center from 2005 to 2024.

Results: The average days of age at diagnosis was two (IQR 1-8). Complex congenital heart disease with TAPVR was diagnosed in eight patients. A supracardiac type of TAPVR was found in 47% of them. The patients underwent the operation on their eighth day of life (IQR 5-57). The follow-up period was 32 months (IQR 8-99). The early postoperative mortality rate was 17.5%, significantly frequent in the patients' group with combined CHD (p = 0.002). Four were reoperated on-three due to a postoperative obstruction between the pulmonary venous confluence and the left atrium (LA), while in one patient, a redirection of the VCI was performed. Four patients, aged 12.3 on average (IQR 8.9-14.7), underwent vertical vein embolization. All patients achieved complete occlusion with AVP2. The LA diameter Z score was lower than -4, an increased risk for VV persistence of almost 19 times (OR 18.6, 95% CI 1.6-216.0).

Conclusions: We found that an LA diameter Z score of lower than -4 was a major risk factor for VV persistence. Percutaneous VV embolization is a safe and effective procedure in adolescents.