Journal of Pediatric Cardiology and Cardiac Surgery

Background: Total anomalous pulmonary venous connection (TAPVC) has several morbid conditions. Particularly, treatment outcomes of patients with TAPVC who postoperatively develop pulmonary venous obstruction (PVO) remain unsatisfactory. We investigated the usefulness of 320-row multidetector computed tomography (CT) imaging for early detection of postoperative PVO.

Methods: We included 18 consecutive patients who postoperatively underwent chest CT using 320-row multidetector CT during June 2007–December 2018 in Iwate Medical University Hospital.

Results: TAPVC types were supracardiac (in 3 patients), cardiac (4), infracardiac (6), and mixed (5). PVO was found preoperatively in 10 patients and postoperatively in 4. Median age and radiation exposure dose were 133 (33–556) days and 0.65 (0.40–1.32) mSv, respectively, when postoperative CT was employed. The anastomotic site between the common chamber and the atrium was located in front of the spine in 9 patients (central type), whereas it was deviated to the right/left side of the spine with the pulmonary vein (PV) coursing over the descending aorta and the spine in the remaining 9 patients (lateral type). Among those, CT revealed PV flattening and anastomotic stenosis in 9, and 4 of them were subjected to surgical PVO relief due to significant pulmonary congestion. In two of the four patients reoperated, PVO clinically developed eventually; PVO had not been recognized initially due to limited imaging window and presumably compromised PV flow at the affected site.

Conclusions: 320-row multidetector CT with a low radiation exposure dose could aid in early diagnosis of PVO in the peripheral region.