title: Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives.
abstract: OBJECTIVE
  Review of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair.
  
  
  METHODS
  A retrospective observational case series. METHODOLGY: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages) and mean ΁ SD respectively.
  
  
  RESULTS
  A total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period.
  
  
  CONCLUSIONS
  The primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.
authors.affiliation: Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Aggarwal
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Gadhinglajkar
authors.forename: Rupa
authors.initials: R
authors.lastname: Sreedhar
authors.forename: Baiju S
authors.initials: BS
authors.lastname: Dharan
authors.forename: Keerthi
authors.initials: K
authors.lastname: Chigurupati
authors.forename: Saravana
authors.initials: S
authors.lastname: Babu
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000601:surgery