Sinus node dysfunction after repair of partial anomalous pulmonary venous connection.
OBJECTIVE
Sinus node dysfunction is known as a major complication after repair of partial anomalous pulmonary venous connection. We retrospectively analyzed the results of the atrial wall flap technique compared with the results of patch repair or direct suturing in the intra-atrial tunnel technique.


METHODS
Between 1991 and 2007, 23 patients (mean age, 6 years; range, 5 months-17 years) with partial anomalous pulmonary venous connection underwent surgical intervention. The right anomalous pulmonary veins drained to either the right atrium or superior vena cava in 8 and 15 patients, respectively. Patients were divided into 2 groups: group F (n = 14), who had repair with an atrial flap, and group N (n = 9), who had repair without an atrial flap. All patients had normal sinus rhythm preoperatively.


RESULTS
No patients had signs of superior vena cava or pulmonary venous obstruction within a mean follow-up of 4.8 years. One patient in group F required pacemaker implantation. In the early postoperative period, sinus node dysfunction developed in 93% of group F and 44% of group N patients (P < .01) and was prolonged until discharge in 57% of group F and 0% of group N patients (P < .01). At the most recent clinical visit, sinus node dysfunction was identified in 50% of group F patients, whereas all patients in group N had normal sinus rhythm (P < .02).


CONCLUSIONS
The atrial flap technique, which requires incision or suture crossing the crista terminalis, could cause sinus node dysfunction, whereas the intra-atrial rerouting method with a patch or direct suture maintains normal sinus node function postoperatively.
Takahashi
Hiroaki
H
Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. takahashi-cvs@hotmail.co.jp
Oshima
Yoshihiro
Y
Yoshida
Masahiro
M
Yamaguchi
Masahiro
M
Okada
Kenji
K
Okita
Yutaka
Y
D000293:Adolescent; D001146:Arrhythmia, Sinus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011667:Pulmonary Veins / Q000002:abnormalities / Q000601:surgery*; D012307:Risk Factors; D014683:Vena Cava, Superior / Q000601:surgery