M Lev

Bio: M Lev is an academic researcher. The author has contributed to research in topics: Heart septal defect. The author has an hindex of 1, co-authored 1 publications receiving 54 citations.

Total anomalous pulmonary venous connection: long-term appraisal with evolving technical solutions.

Abstract: Objectives: To evaluate late outcome of non-isomeric total anomalous pulmonary venous connection (TAPVC) repair, controlling for anatomic subtypes and surgical technique. Methods: Between 1983 and 2001, 89 patients (median age 54 days) underwent repair for supracardiac (38), cardiac (26), infracardiac (16) or mixed (nine) TAPVC. Ten patients (11.2%) presented associated anomalies other than PDA. Twenty-eight patients (31.5%) were emergencies, due to obstructed drainage. Supracardiac and infracardiac TAPVC repair included the double-patch technique with left atrial enlargement in 29 patients and side-to-side anastomosis between the pulmonary venous (PV) confluence and the left atrium in 29 patients. Coronary sinus unroofing was preferred for cardiac TAPVC repair. Total follow-up was 727.16 patient-years (mean 8.55 years, 98.8% complete). Results: Early mortality was 7.86% (7/89). Ten patients (11.2%) underwent reintervention, including reoperation (eight), balloon dilation (one) and intraoperative stents placement (one), for anastomotic (four) or diffuse PV stenosis (six), with four late deaths. Kaplan‐Meier survival is 87.3 ^ 0.036 SE% at 18.07 years with no difference according to anatomic type or surgical technique. Freedom from PV reintervention for operative survivors is 86.7 ^ 0.052 SE% at 18.07 years. Cox proportional hazard indicates associated anomalies (P ¼ 0:008) and reoperation for intrinsic PV stenosis (P ¼ 0:034) as independent predictors of mortality. According to logistic analysis, preoperative obstruction predicts higher risk of reintervention for intrinsic PV stenosis (P ¼ 0:022), while the double-patch technique increased the risk of late arrhythmias (P ¼ 0:005). Conclusions: Side-to-side anastomosis provides excellent results for TAPVC repair while left atrial enlargement procedures appear to be associated with higher risk of late arrhythmias. Although early and aggressive reintervention for recurrent PV obstruction is mandatory, intrinsic PV stenosis remains a predictor of adverse outcome. q 2002 Elsevier Science B.V. All rights reserved.

Total anomalous pulmonary venous connection beyond infancy.

Abstract: Most patients with total anomalous pulmonary venous connection are operated on in infancy, with low mortality and morbidity, but in developing countries, we still encounter patients beyond infancy. We describe our experience in 26 patients aged 1-16 years (mean, 5.01 years), with total anomalous pulmonary venous connection, who underwent correction between June 2007 and December 2009. Eleven patients were >5-years old. Transthoracic echocardiography was diagnostic in all cases. Mean intensive care unit stay was 2.3 ± 0.87 days, and hospital stay was 9.23 ± 2.34 days. There were no early deaths and no major postoperative complications. Follow-up ranged from 10-40 months. Pulmonary artery pressure, as judged by echocardiography, reduced significantly in all patients. Repair of total anomalous pulmonary venous connection beyond infancy can be carried out safely with acceptable results.