About TAPVC Procedure

Total anomalous pulmonary venous connection(TAPVC) which is also known as the total anomalous pulmonary venous return is an infrequent cyanotic congenital heart defect in which all of the four pulmonary veins are malpositioned and make atypical connections to the systemic venous circulation.

This is a defect in the veins which leads from the lungs to the heart. In TAPVC, the blood fails to take the normal route from the lungs to the heart and out to the body. Rather, the veins from the lungs attach to the heart in abnormal positions and this problem means that oxygenated blood enters or it starts leaking into the wrong chamber.

TAPVC Surgery

This defect is surgically repaired, at the time of open-heart surgery, the pulmonary veins are reconnected to the left atrium and the atrial septal defect is sealed. The surgical redirection can be performed within the first month of life. All of the four pulmonary veins are reconnected to the left atrium, and any linked heart defects such as atrial septal defect, ventricular septal defect, patent foramen ovale, and patent ductus arteriosus are surgically closed.

TAPVC in Singapore

TAPVC surgery is performed by a Cardiologist. To become a cardiologist one may have to graduate from a university, then four more years of education at the medical school. After that, the medical license is obtained. The next three years involves training with a residency in internal medicine and then one must complete a cardiology fellowship that lasts for another three years.

Singapore offers the best hospitals like Mount Elizabeth Hospital and Thomson Medical Center, amongst the other well-equipped hospitals and highly trained cardiologists who have gone under extensive training and are highly competent like Dr. Ong Kim Kiat and Dr. Sriram Shankar.

Cost Comparison

The cost of surgery range is around 5000 USD to 8500 USD, it is comparatively less than countries like the UK and US and has laudable services and facilities.

Treatment and Cost

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Total Anomalous Pulmonary Venous Connection (TAPVC) or Total Anomalous Pulmonary Venous Return (TAPVR) is a rare congenital disorder characterized by a malformation in all the four pulmonary veins that carry oxygenated blood from the lungs to the atrium. The malformation is such that the veins do not connect to the left atrium perfectly.

In case of TAPVC, the four pulmonary veins drain into the right atrium because of an anomalous connection. There are different TAPVC types, depending on where and how the pulmonary veins drain into the right atrium. The common TAPVC types include supracariac, cardiac, and infracardiac TAPVC.

All types of TAPVC are corrected with the help of a surgery, which is conducted during infancy itself. Additionally, all types of TAPVC almost always have an atrial septal defect (ASD), which requires a separated surgery for its closure. An ASD is a hole between the upper two chambers of the heart. As a result, some amount of oxygenated blood from the right atrium is transferred to the left atrium and out from the body.

TAPVC Symptoms

TAPVC is detected as soon as the baby is born or even before. The following are some of the main TAPVC symptoms:

  • Low oxygen saturation
  • Less blood volume in the left atrium and ventricle
  • Obstruction of the pulmonary veins
  • Congestion in the lungs
  • Pulmonary hypertension
  • Severe cyanosis (bluish appearance of the skin)
  • Unstable blood pressure

TAPVC repair is conducted as soon as the condition is diagnosed, which may happen during pregnancy or after the birth of the baby. However, the exact time as to when the repair is conducted depends on the overall health of the baby. During TAPVC repair, the neonatal cardiac surgeons connect the pulmonary veins to the back of the left atrium to restore the normal flow of blood to the heart. Additionally, they also close off any abnormal connection between the pulmonary veins. The TAPVC repair procedure does not end there. The last step in the repair mostly includes the closure of the ASD. Prior to the surgery, the body of the child is connected to an artificial heart-lung machine.  The machine is disconnected as soon as the normal beating of the heart is restored after making doing all the corrective repairs.

TAPVC repair success rate is excellent with over 95 percent success rate in children who are treated electively. A child or an adult may undergo TAPVR surgery successfully, however, that does not mean that it is fully cured. They will have to attend follow-up appointments with the surgeon in the future on a regular basis. The success rate, on the other hand, is low when the procedure is conducted on an emergency basis in critically-ill infants. Even if infants do survive after undergoing emergency TAPVC repair procedure, they will be kept under a prolonged post-surgery intensive care. They are also put on a ventilator machine to assist breathing.

Even is the repair is successfully handled, the patient is required to attend follow-up session with the surgeon for the rest of your life. During the follow-up appointments, the surgeon will check the progress and keep a tap on health conditions that may develop as the child grows into an adult. Most of the children who undergo TAPVC repair and ASD closure are able to grow and develop normally. Abnormal cardiac rhythm and obstruction in the pulmonary veins are the two post-surgical complications that may rarely occur.

Frequently Asked Questions

Singapore is generally known for its well-managed health care infrastructure and has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000. Bloomberg ranked Singapore's healthcare system the most efficient in the world in 2014. Three main healthcare groups exist in Singapore:
  • National Healthcare Group
  • National University Health System
  • SingHealth
The 10 public hospitals in Singapore comprise 8 general hospitals (AH, SGH, NUH, CGH, TTSH, KTPH, NTFGH & SKH), and 2 specialized hospitals (KKH & IMH). In addition, there are 9 national specialty centres for cancer (NCCS & NCIS), cardiac (NHCS & NUHCS), eye (SNEC), skin (NSC), neuroscience (NNI) and dental care (NDCS & NUCOHS). The private healthcare infrastructure in Singapore is also well established. The payment methods include private payment gateways or private insurance companies. You can expect better technology to be used in private hospitals in Singapore. Various procedures like stem cell therapy and cancer research are conducted in Singapore.
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are some of the JCI certified hospitals in Singapore :
  • Mount Elizabeth Hospital
  • Singapore National Eye Centre
  • National Dental Centre
  • Raffles Hospital
  • National University Hospital
  • Gleneagles Hospital
  • Singapore General Hospital
  • National Heart Centre Singapore
  • Changi General Hospital
  • National Cancer Centre
  • National Skin Centre
  • Johns Hopkins Singapore International Medical Centre
  • Tan Tock Seng Hospital
Since Singapore is known all over the world for some of the best medical treatments all across the globe, you can surely expect the best quality of doctors and surgeons here. This country has a very high quality of life and hence the health of people is of high priority.
People who wish to go to Singapore as a tourist for social purposes or seeking medical treatment, and require a longer period of stay beyond the Visit Pass granted on entry into Singapore, may submit an application for extension of stay (not more than 89 days from date of entry) online using the e-Service of ICA. All extension applications must be submitted online using the e-service at least seven days prior to the expiry of the visit pass to avoid overstaying. Extension of visit will not be accepted over the counter. Every visit pass issued to any person as a tourist or for the purpose of a social visit or medical treatment shall be subjected to the condition that the holder shall not engage in any form of employment (paid or unpaid) or in any business, profession or occupation in Singapore during the validity of that pass unless he is a holder of a valid work pass issued under the Employment of Foreign Manpower Act. Do visit the ICA website for further information.
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