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Congress: ECR25
Poster Number: C-26998
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-26998
Authorblock: J. P. Johnson, S. Garg, H. Panwala; Mumbai/IN
Disclosures:
Jithin Pothen Johnson: Nothing to disclose
Sonal Garg: Nothing to disclose
Hirenkumar Panwala: Nothing to disclose
Keywords: Cardiac, Paediatric, Veins / Vena cava, CT, CT-Angiography, Surgery, Congenital
Learning objectives To highlight the anatomic heterogeneity of mixed type of total anomalous pulmonary venous connection (TAPVC)- the most complex amongst the types of TAPVC. To evaluate the imaging-based classification systems proposed thus far and correlate with our radio-surgical findings and outcome. To suggest our own image-based guidelines that are paramount to guide surgical decisions. To highlight important points to be mentioned while reporting mixed TAPVC cases which provide the surgeon with vital information, thus aiding in improved surgical outcome.
Read more Background The mixed type of TAPVC is the most challenging type of TAPVC, in terms of timely diagnosis and management, being the least common type but also the type with the highest mortality. Over the years, contrast enhanced CT angiography has proven its superiority over echocardiography in accurate delineation of the complex pulmonary venous anatomy for guiding pre-surgical planning and thus improving the post-operative outcome. It also has the advantage of simultaneous assessment of the lung parenchyma and airway which plays...
Read more Findings and procedure details The pre-operative CT anatomic delineation showed 100% correlation with the true anatomical configuration found at surgery. Of the eight patients who were diagnosed as mixed TAPVC, three patients had type I configuration (3+1), one patient had type II configuration (2+2) and four patients had type III configuration (Bizarre pattern) as per the Choudhury classification. While the term ‘bizarre’ denotes a complex, unclassifiable anatomy, some of the cases in this category were not as surgically challenging as anticipated and hence, although...
Read more Conclusion Pre-operative, dual phase cardiac CT has made it possible to provide the surgeon with all the necessary details to plan immediate surgery in early infancy with an accurate roadmap of pulmonary venous anatomy, tremendously improving the outcome of this otherwise complex and challenging condition.The length and size of individual veins, as well as the presence of anatomic osteal narrowing, are more significant factors in determining the degree of surgical complexity than just the venous drainage pattern. The surgery must be...
Read more References Chowdhury, Ujjwal K. et al. Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results The Journal of Thoracic and Cardiovascular Surgery, Volume 135, Issue 1, 106 - 116.e5 Xiang M, Wu C, Pan Z, Wang Q, Xi L. Mixed type of total anomalous pulmonary venous connection: diagnosis, surgical approach and outcomes. J Cardiothorac Surg. 2020 Oct 2;15(1):293. doi: 10.1186/s13019-020-01332-7. PMID: 33008456; PMCID: PMC7532098. Furlanetto G, Furlanetto BH, Henriques SR, Lopes LM, Miranda ET, Porto CM, Pereira ME, Davini C,...
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