Partial anomalous pulmonary venous connection to the superior vena cava.
BACKGROUND
Repair of partial anomalous pulmonary venous connection (PAPVC) to the high portion of the superior vena cava (SVC) may be complicated by atrial arrhythmia and obstruction of the pulmonary veins or SVC. We reviewed our experience with the modified Warden technique, in which the SVC was transected and anastomosed to the right atrial appendage with anterior augmentation of pedicled autologous pericardial flap, and the atrial septum was directly displaced to the SVC orifice.


METHODS
Twenty of 51 patients with PAPVC underwent this technique. Mean age was 11.9 years. Follow-up averaged 6.5 years. To quantify the height of insertion of anomalous pulmonary veins, the distance between the highest anomalous pulmonary venous orifice and SVC-right atrial junction was indexed by thoracic vertebral body height (height index).


RESULTS
All patients are alive in sinus rhythm. No patients exhibited pulmonary venous obstruction, and mean flow was 0.61 mL. Mean flow of SVC return was 0.79 mL. The SVC occlusion occurred in 2 patients who had persistent left SVC with a good communicating vein. Three patients whose height index exceeded 2.5 successfully underwent catheter intervention at the SVC channel.


CONCLUSIONS
Midterm results with the modified Warden technique were satisfactory. Patients with particularly high insertion of anomalous pulmonary veins should be treated and followed with specific caution for preserving an unobstructed caval pathway.
Nakahira
Atsushi
A
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Yagihara
Toshikatsu
T
Kagisaki
Koji
K
Hagino
Ikuo
I
Ishizaka
Toru
T
Koh
Masahiro
M
Uemura
Hideki
H
Kitamura
Soichiro
S
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000886:Anthropometry; D020517:Atrial Appendage / Q000601:surgery; D001919:Bradycardia / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011652:Pulmonary Circulation; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000601:surgery