Annals of Pediatric Cardiology
About us | Current Issue | Archives | Ahead of Print | Instructions | Submission | Subscribe | Advertise | Contact | Login 
     
     
 


 

 
     
    Advanced search
 

 
 
     
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed794    
    Printed5    
    Emailed0    
    PDF Downloaded81    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents   
LETTER TO EDITOR  
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 116-117
Improving outcomes in totally anomalous systemic venous connection


Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Click here for correspondence address and email

Date of Web Publication18-Jan-2018
 

How to cite this article:
Sivasubramonian S, Gopalakrishnan A, Sasikumar D, Krishnamoorthy K M. Improving outcomes in totally anomalous systemic venous connection. Ann Pediatr Card 2018;11:116-7

How to cite this URL:
Sivasubramonian S, Gopalakrishnan A, Sasikumar D, Krishnamoorthy K M. Improving outcomes in totally anomalous systemic venous connection. Ann Pediatr Card [serial online] 2018 [cited 2019 Sep 17];11:116-7. Available from: http://www.annalspc.com/text.asp?2018/11/1/116/223542




Sir,

We congratulate the authors for their elegant description and case-based illustration of totally anomalous systemic venous connection (TASVC).[1] We would like to present a few points that the authors could clarify. The concept of connection and the physiology of drainage are well illustrated. We would like to extend the concept of venoatrial concordance here, in that the systemic venous drainage in left isomerism is always discordant venoatrial connection, but can be physiologically concordant by its drainage into pulmonary arteries from the right side. Then, the systemic veins draining into left-sided atrium have both physiological and anatomical discordance and major surgical implications.

The failure of the right atrium and the tricuspid annulus to grow in TASVC is understandably related to the preload deprivation as explained by the authors. Is it not possible that the process of altered growth may not be entirely limited to the intrauterine period? In such a scenario, the natural history of these patients could potentially be altered by early diagnosis and venous rerouting surgical options early in infancy, thereby rendering the patient a candidate for a one-and-half or biventricular repair later in life.

An analogous situation would be the infant who presents with a large atrial septal defect (ASD) with torrential left-to-right shunt augmented by mildly hypoplastic left ventricular inflow. In this example, the left heart tends to grow after ASD closure early in infancy.[2]

We also appreciate the authors to have achieved good success after bidirectional Glenn surgery in the first patient with elevated pulmonary artery mean pressures and high pulmonary vascular resistance at the age of 13 years. We would like to know the outcome of this child. Could the natural history of the patient have been better if she had presented early in infancy? It is good to know that both nature and surgeons are revising the limitations of creating a Fontan circuit so that current limitation of age and pulmonary vascular resistance is revised to higher numbers.[3],[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gupta SK, Juneja R, Anderson RH, Gulati GS, Devagorou V. Clarifying the anatomy and physiology of totally anomalous systemic venous connection. Ann Pediatr Cardiol 2017;10:269-77.  Back to cited text no. 1
[PUBMED]    
2.
Phoon CK, Silverman NH. Conditions with right ventricular pressure and volume overload, and a small left ventricle: “Hypoplastic” left ventricle or simply a squashed ventricle? J Am Coll Cardiol 1997;30:1547-53.  Back to cited text no. 2
[PUBMED]    
3.
Stern HJ. Fontan “Ten commandments” revisited and revised. Pediatr Cardiol 2010;31:1131-4.  Back to cited text no. 3
[PUBMED]    
4.
Saran M, Sivasubramonian S, Abhilash SP, Tharakan JA. Acquired Fontan paradox in isolated right ventricular cardiomyopathy. Ann Pediatr Cardiol 2016;9:251-3.  Back to cited text no. 4
[PUBMED]    

Top
Correspondence Address:
Dr. Sivasankaran Sivasubramonian
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_133_17

Rights and Permissions




 

Top