title: Anomalous pulmonary venous connection to superior vena cava: Warden technique.
abstract: OBJECTIVE
  Repair of anomalous pulmonary venous connection (APVC) to superior vena cava (SVC) with internal pericardial patch may be complicated by the obstruction of the SVC or pulmonary veins and sinus node dysfunction. Moreover, the shrinkage of the pericardium may lead to late obstruction. Various techniques are practiced, which have reduced the incidence of obstruction to the venous drainage, but sinus node dysfunction continues to be an issue. We reviewed our experience with the Warden technique, predominantly in children, for various types of APVC to the SVC.
  
  
  METHODS
  Between 2006 and 2010, 32 patients with anomalous drainage of the pulmonary veins to SVC underwent repair by the Warden technique in our institute. The median age at operation was 4 years (range 3 months-34 years). Partial anomalous pulmonary venous connection (PAPVC) was present in 28 patients, while four patients had total anomalous pulmonary venous connection (TAPVC) to the SVC, where one or more pulmonary veins joined the SVC separately from the entry of the common chamber. Clinical data, echocardiography and operative details were collected from our database, retrospectively.
  
  
  RESULTS
  At a median follow-up of 24 months, there was no mortality. One patient had transient rhythm disturbance. On follow-up, it was revealed that all patients are in sinus rhythm with no evidence of systemic or pulmonary venous obstruction.
  
  
  CONCLUSIONS
  The Warden technique is a simple and effective surgical option, which should be preferred for patients with anomalous drainage of the pulmonary veins to SVC. Though arrhythmias are rare in the early follow-up, longer follow-up is required to rule out their late development.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Medical College, Trivandrum 695011, Kerala, India. drbrijeshpk00@gmail.com
authors.forename: Brijesh P
authors.initials: BP
authors.lastname: Kottayil
authors.forename: Baiju S
authors.initials: BS
authors.lastname: Dharan
authors.forename: Sabarinath
authors.initials: S
authors.lastname: Menon
authors.forename: Sasidharan
authors.initials: S
authors.lastname: Bijulal
authors.forename: Praveen Kumar
authors.initials: PK
authors.lastname: Neema
authors.forename: Shyamkrishnan K
authors.initials: SK
authors.lastname: Gopalakrishnan
authors.forename: Karunakaran
authors.initials: K
authors.lastname: Jayakumar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D016157:Vascular Fistula / Q000601:surgery*; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult