Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients Yasuhiro Kotani,

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Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients Yasuhiro Kotani, MD, PhD, Jiaquan Zhu, MD, PhD, Lars Grosse-Wortmann, MD, Osami Honjo, MD, PhD, John G. Coles, MD, Glen S. Van Arsdell, MD, Christopher A. Caldarone, MD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 5, Pages 1332-1338 (May 2015) DOI: 10.1016/j.jtcvs.2014.11.089 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Hypothesis of anatomic factor contributing left-sided pulmonary vein obstruction. Arrow shows narrowed left pulmonary vein between the heart and descending aorta. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1332-1338DOI: (10.1016/j.jtcvs.2014.11.089) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Measurement of intrathoracic structures by cardiac magnetic resonance. Axial slice at the level of left lower pulmonary vein was chosen from cardiac magnetic resonance. All measurement was normalized by thoracic dimension. Antero-posterior dimension: (posterior sternal plate to anterior margin of vertebra)/(posterior sternal plate to posterior margin of the lungs). Horizontal dimension: (maximum horizontal dimension of thoracic cavity)/(posterior sternal plate to posterior margin of the lungs). Distance from vertebra to aorta: distance from anterior margin of vertebra to center of descending aorta normalized by using vertical and horizontal dimension of thoracic cavity. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1332-1338DOI: (10.1016/j.jtcvs.2014.11.089) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Left lower pulmonary vein before and after sutureless repair. A, Before sutureless repair, the left lower PV is narrowed by compression of the heart and descending aorta. B, After sutureless repair, the confluence of the left lower PV to the atrium is well augmented. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1332-1338DOI: (10.1016/j.jtcvs.2014.11.089) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Relationship between clinical outcomes and anatomic characteristics. Patients with left-sided PVO (circle) had more cardiomegaly and antero-laterally located descending aorta compared with patient without PVO (diamond). Cardiomegaly was associated with failed Fontan completion (closed diamond). PVO, Pulmonary vein obstruction. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1332-1338DOI: (10.1016/j.jtcvs.2014.11.089) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Combination of cardiomegaly and antero-latellary located descending aorta is a risk for left PVO. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1332-1338DOI: (10.1016/j.jtcvs.2014.11.089) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions