Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap.
BACKGROUND
Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications.


METHODS
Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials.


RESULTS
No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months).


CONCLUSIONS
Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Chilsung
C
Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Yang Hyun
YH
Cho
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Mina
M
Lee
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Ji-Hyuk
JH
Yang
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Tae-Gook
TG
Jun
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Jin Young
JY
Song
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
June
J
Huh
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
I-Seok
IS
Kang
Congenital heart disease (CHD); Modified Warden procedure; Partial anomalous pulmonary venous connection (PAPVC)