title: Repair of Persistent Left Superior Vena Cava to Unroofed Coronary Sinus Defect by Retro-Aortic Implantation (Modified Warden Type Procedure).
abstract: BACKGROUND
  Repair of unroofed coronary sinus defect in the presence of left superior vena cava is challenging and requires prosthetic graft material to redirect flow to the right atrium. This may potentially cause a supra-mitral gradient or pulmonary venous obstruction.
  
  
  METHODS
  Three patients with unroofed coronary sinus in the presence of a left superior vena cava (LSVC) underwent modified cavo-atrial anastomosis (Warden technique) to achieve reimplantation of the LSVC in a retro-aortic fashion to the right atrial appendage.
  
  
  RESULTS
  Three patients recovered well with no evidence of an intracardiac shunt. Postoperative echocardiography demonstrated normal venous flows in the LSVC.
  
  
  CONCLUSIONS
  This modified technique offers correction of this systemic venous anomaly without the need for any additional graft material.
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom.
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Muthialu
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom.
authors.forename: Diana
authors.initials: D
authors.lastname: Fajardo
authors.affiliation: Department of Cardiology, Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Sullivan
authors.affiliation: Department of Cardiothoracic Surgery, Great Ormond Street Hospital, Great Ormond Street, London, United Kingdom.
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D054326:Coronary Sinus / Q000002:abnormalities* / Q000601:surgery; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000637:transplantation