Title : Multidisciplinary management of total anomalous pulmonary venous return: Acute effects of early postoperative physiotherapy
Abstract:
Total Anomalous Pulmonary Venous Return (TAPVR) is a rare congenital heart defect characterized by the failure of pulmonary veins to connect normally to the left atrium. We report the case of a 22-year-old patient diagnosed with TAPVR, without any family history of the condition. The patient had previously undergone an exercise stress test and had been receiving hormone therapy, including a two-year course of testosterone. Clinically, the patient presented with tachycardia and exertional dyspnea. Health-related quality of life was initially assessed using the MacNew Heart Disease Health-related Quality of Life Questionnaire, yielding a mean score of 4.44. Psychological assessment with the Tampa Scale for Kinesiophobia revealed a total score of 40, indicating a high level of kinesiophobia, while body awareness was evaluated with a standardized scale, with a total score of 75 (out of 90), reflecting a moderate level of body awareness despite physical limitations. Postoperatively, a structured cardiopulmonary physiotherapy program was initiated within 48–72 hours. The early rehabilitation protocol included cycles of active breathing techniques, PEP/Bubble PEP therapy, incentive spirometry, early mobilisation, posture and thoracic mobilisation exercises, as well as family education. The acute effects of these interventions were favorable, leading to improvements in respiratory function, reduction of dyspnea, enhanced thoracic expansion, and earlier functional mobilisation. Follow-up assessments demonstrated a decrease in kinesiophobia from 40 to 28 points (30% reduction), an increase in body awareness from 75 to 82 points (9.3% improvement), and an improvement in health-related quality of life (MacNew) from 4.44 to 5.20 (17% increase in mean score).
This case highlights the complexity of managing adult patients with congenital cardiac anomalies, particularly when compounded by prior hormonal therapy and psychological factors such as kinesiophobia. Furthermore, it emphasizes that early, structured cardiopulmonary rehabilitation can play a pivotal role in enhancing postoperative recovery, reducing psychological barriers, and optimizing quality of life in patients with rare congenital heart diseases.
