title: Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava.
abstract: BACKGROUND
  Correction of a high partial anomalous pulmonary venous (PV) connection to the superior vena cava (SVC) may be complicated by sinus node dysfunction, or SVC or PV obstruction. We have used the caval division technique when the anomalous PV insert high above the cavoatrial junction and report our long-term outcome.
  
  
  METHODS
  Between 1990 and 2009, 178 consecutive patients underwent operations for a partial anomalous PV connection. Caval division was used in 41 patients (23%). Median age was 34 years (range, 1.3 to 76 years). Thirty patients (73%) had an atrial septal defect. Eighteen patients (44%) underwent Warden procedure in which the SVC was divided, the upper end was connected to the right atrial appendage, and the remaining SVC served as a conduit for PV drainage to the left atrium through the atrial septal defect. A modified Warden was performed in 17 patients (41%) using a short ringed interposition graft between the SVC and the right atrial appendage. Six patients (15%) with persistent left SVC underwent right SVC division without reimplantation.
  
  
  RESULTS
  No early deaths occurred. One Warden group patient (5%) required early reoperation for SVC obstruction. One patient (2%) with atrial fibrillation underwent a concomitant Maze procedure and permanent pacemaker implantation for tachybrady syndrome. All other patients remained in sinus rhythm at follow-up. Follow-up was complete in all patients (mean, 2±2.6 years; maximum, 14 years). One noncardiac-related death occurred at 14 years. SVC obstruction developed in 3 Warden group patients (17%) and was managed with angioplasty and stenting. No patient had pulmonary vein stenosis on follow-up.
  
  
  CONCLUSIONS
  Caval division techniques appear to be effective, with low morbidity and mortality. The modified Warden procedure may decrease the risk of SVC obstruction. Late arrhythmias or PV obstruction are uncommon.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sameh M
authors.initials: SM
authors.lastname: Said
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Ben
authors.initials: B
authors.lastname: Eidem
authors.forename: Paul
authors.initials: P
authors.lastname: Stensrud
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Phillips
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult