Effectiveness of posterior aortopexy for the left pulmonary vein
obstruction between the left atrium and the descending aorta
Background: Left pulmonary vein (PV) obstruction can occur due to
compression between the left atrium (LA) and the descending aorta (DA).
One of the effective solutions for this problem is posterior aortopexy.
In this study, we have reported five cases of posterior aortopexy to
relieve left PV obstruction between the LA and the DA. Methods: Since
August 2012, five patients have undergone posterior aortopexy for
compression of the left PV between the LA and the DA. The median age and
weight of the patients at the time of operation were 5.5 months (range,
1-131 months) and 5.2 kg (range, 4.2-29.5 kg), respectively. The left PV
obstruction was initially diagnosed on echocardiography in four patients
and computed tomography angiography in one patient. The median peak
pressure gradient across the obstructed left PV was 7.3 mmHg (range,
4-20 mmHg). Concomitant procedures were ventricular septal defect
closure in one patient and patent ductus arteriosus ligation in one
patient. Results: There was no PV obstruction on echocardiography in any
of the patients after the operation except in the case of one patient
who had diffuse pulmonary vein stenosis. The median follow-up duration
was 34 months (range, 14-89 months), and during follow-up no incidence
of the left PV obstruction was observed in any of the surviving
patients. Conclusions: The posterior aortopexy technique could be a good
surgical option for the left PV obstruction caused by compression
between the LA and the anteriorly positioned DA.