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The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

Published online by Cambridge University Press:  19 August 2020

Hesham Alkady Open the ORCID record for Hesham Alkady [Opens in a new window] ,
Ahmed Elnaggar ,
Mahmoud Eldegwy  and
Abdallah Nosair
Hesham Alkady*
Affiliation:
Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Ahmed Elnaggar
Affiliation:
Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Mahmoud Eldegwy
Affiliation:
Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
Abdallah Nosair
Affiliation:
Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
*
Author for correspondence: Hesham Alkady, Kasralaini str., Almanial, Cairo, Egypt. Tel: +20 1006246611; Fax: +0020 37807183. E-mail: [email protected]
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Abstract

Introduction:

In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years.

Patients and methods:

In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study.

Results:

In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) could be followed up for a mean period of 7.8 ± 1.2 years after discharge. During the follow-up period, no stenosis was detected in the Warden anastomosis or the rerouted pulmonary veins and only one case of late mortality (1.6%) occurred due to a non-cardiac cause.

Conclusion:

The Warden procedure is a safe approach for the repair of high PAPVCs (above the cavoatrial junction) in the paediatric age group with good long-term results and low incidence of complications like sinus node dysfunction as well as pulmonary vein and superior caval vein obstruction.

Keywords

Sinus venosus atrial septal defectpartial anomalous pulmonary venous connectionsWarden proceduresinus node dysfunctionpulmonary vein stenosis
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1486 - 1489
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Alsoufi, B, Cai, S, Van Arsdell, GS, et al. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. Ann Thorac Surg 2007; 84: 2020–2026.CrossRefGoogle ScholarPubMed
Sojak, V, Sagat, M, Balazova, E, et al. Outcomes after surgical repair of sinus venosus atrial septal defect in children. Bratisl Lek Listy 2008; 109: 215–219.Google ScholarPubMed
Said, SM, Burkhart, HM, Schaff, HV, et al. Singlepatch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: Does it matter? J Thorac Cardiovasc Surg 2012; 143: 896–903.CrossRefGoogle ScholarPubMed
Kottayil, BP, Dharan, BS, Menon, S, et al. Anomalous pulmonary venous connection to superior vena cava: Warden technique. Eur J Cardiothorac Surg 2011; 39: 388–391.CrossRefGoogle ScholarPubMed
Aggarwal, N, Gadhinglajkar, S, Sreedhar, R, et al. Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: anesthesia and transesophageal echocardiography perspectives. Ann Card Anaesth 2016; 19: 293–299.CrossRefGoogle ScholarPubMed
Tacy, TA Systemic and pulmonary venous anomalies. In: Wong, PC, MillerHance, WC (eds). Transesophageal Echocardiography for Congenital Heart Disease. SpringerVerlag, Los Angeles, 2014: 145–168.CrossRefGoogle Scholar
Stewart, RD, Bailliard, F, Kelle, AM, et al. Evolving surgical strategy for sinus venosus atrial septal defect: effect on sinus node function and late venous obstruction. Ann Thorac Surg 2007; 84: 1651–165.CrossRefGoogle ScholarPubMed
Okontaa, KE, Agarwal, V Does Warden’s procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection? Interact Cardiovasc Thorac Surg 2012; 14: 839–842.CrossRefGoogle Scholar
Tao, K, Pan, W, Lin, K, et al. Modified cavoatrial anastomosis in Warden procedure. Ann Thorac Surg 2010; 89: 2047–2048.CrossRefGoogle ScholarPubMed
Shahriari, A, Rodefeld, MD, Turrentine, MW, et al. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg 2006; 81: 224–229.CrossRefGoogle ScholarPubMed
Chandra, D, Gupta, A, Nath, AK, Kazmi, A, Grover, V, Gupta, VK. Surgical management of anomalous pulmonary venous connection to the superior vena cava – early results. Indian Heart J 2013; 65: 561–565.CrossRefGoogle ScholarPubMed
Zhu, J, Kotani, Y, Chetan, D, et al. Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair? Ann Thorac Surg 2014; 97: 1664–1670 CrossRefGoogle ScholarPubMed
Said, SM, Burkhart, HM, Dearani, JA, et al. Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava. Ann Thorac Surg 2011; 92: 980–984.CrossRefGoogle ScholarPubMed
DiBardino, DJ, McKenzie, ED, Heinle, JS, et al. The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein. Cardiol Young 2004; 14: 64–67.CrossRefGoogle ScholarPubMed
Park, CS, Kwak, JG, Lee, C, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg 2012; 41: 261–265.CrossRefGoogle ScholarPubMed
Yong, MS, Griffiths, S, Robertson, T, et al. Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children. Interact Cardiovasc Thorac Surg 2018; 27: 422–426.CrossRefGoogle ScholarPubMed