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The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein

Published online by Cambridge University Press:  20 January 2005

Daniel J. DiBardino ,
E. Dean McKenzie ,
Jeffrey S. Heinle ,
Jason T. Su  and
Charles D. Fraser
Daniel J. DiBardino
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, TX, USA
E. Dean McKenzie
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, TX, USA
Jeffrey S. Heinle
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, TX, USA
Jason T. Su
Affiliation:
Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
Charles D. Fraser
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract

Purpose: When there is partially anomalous pulmonary venous connection to the superior caval vein, intracardiac repair alone can result in obstruction. Although the Warden procedure involving translocation of the superior caval vein is commonly performed as an alternative to atriocavoplasty, follow-up of a larger number of patients in the modern era is lacking. We report and discuss the experience of a single institution with the Warden procedure for correction of partially anomalous pulmonary venous connection to the superior caval vein. Methods: Since 1995, all 16 patients presenting with partially anomalous pulmonary venous connection to the superior caval vein underwent the Warden procedure at a mean age of 7.1 ± 4.2 years, with a range from 0.2 to 14.3 years, and a mean weight of 24.7 ± 14.0 kg, with a range from 4.1 to 52.9 kg. There were 9 males and 7 females. In 8 patients, we performed 10 concomitant procedures, including closure of an atrial or ventricular septal defect in 7, and advancement of the aortic arch in the other. Results: There were no deaths, and only one episode of postoperative sinus bradycardia with intermittent junctional rhythm, which resolved spontaneously during temporary atrial pacing. All patients were discharged home in normal sinus rhythm at an average of 4.1 ± 2.2 days after the procedure, with a range from 2 to 10 days. All are currently in the first grade of the New York Heart Association up to 5.6 years postoperatively. There is currently no evidence of sinus nodal dysfunction, nor obstruction of the superior caval vein, in any patient. Conclusion: The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein produces excellent results, preserves the function of the sinus node, and should be routinely considered for the repair of this lesion.

Keywords

Partially anomalous pulmonary venous returnsinus venosus atrial septal defectintracardiac repairatriocavoplasty
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 1 , February 2004 , pp. 64 - 67
Copyright
© 2004 Cambridge University Press

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References

Shuster SR, Gross RE, Colodny AH. Surgical management of anomalous right pulmonary venous drainage to the superior vena cava associated with superior marginal defect of the atrial septum. Surgery 1962; 51: 805–808.Google Scholar
Kirklin JW, Barrett-Boyes BG. Atrial septal defect and partial anomalous pulmonary venous connection. In: Kirklin JW, Barrett-Boyes BG (eds). Cardiac Surgery, 2nd edn. Vol 1. New York, Churchill Livingstone, 1993; 1: 627–630.
Pathi V, Guererro R, MacArthur KJD, Jamieson MPG, Pollock JCS. Sinus venosus defect: Single-patch repair with caval enlargement. Ann Thorac Surg 1995; 59: 1588–1589.Google Scholar
Kyger ER, Frazier OH, Cooley DA, et al. Sinus venous atrial septal defect: Early and late results following closure in 109 patients. Ann Thorac Surg 1978; 25: 44–50.Google Scholar
Trusler GA, Kazenelson G, Freedom RM, Williams WG, Rowe RD. Late results following repair of partial anomalous pulmonary venous connection with sinus venous atrial septal defect. J Thorac Cardiovasc Surg 1980; 79: 776–781.Google Scholar
DeLeon SY, Freeman JE, Ilbawi MN, et al. Surgical techniques in partial anomalous pulmonary veins to the superior vena cava. Ann Thorac Surg 1993; 55: 1222–1226.Google Scholar
Agrawal SK, Khanna SK, Tampe D. Sinus venosis atrial septal defects: surgical follow-up. Eur J Cardiothorac Surg 1997; 11: 455–457.Google Scholar
Gerbode F, Yee J, Rundle FF. Experimental anastomosis of vessels to the heart. Surgery 1949; 25: 556–565.Google Scholar
Lewis FJ. High defects in the atrial septum. J Thorac Surg 1958; 36: 1–11.Google Scholar
Ehrnhoft JL, Theilen EO, Lawrence MS. The surgical treatment of partial and total anomalous pulmonary venous connections. Ann Surg 1958; 148: 249.Google Scholar
Groves CK. Correction of anomalous pulmonary venous drainage into the superior vena cava. Ann Thorac Surg 1967; 4: 301.Google Scholar
Pacifico AD, Kirklin JW. Takedown of cavopulmonary anastomosis (Glenn) during repair of congenital cardiac malformations. J Thorac Cardiovasc Surg 1976; 70: 272.Google Scholar
Warden HE, Gustafson RA, Tarnay TJ, Neal WA. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 1984; 38: 601–605.Google Scholar
Williams WH, Zorn-Chelton S, Raviele AA, et al. Extracardiac atrial pedicle conduit repair of partial anomalous pulmonary venous connection to the superior vena cava in children. Ann Thorac Surg 1983; 38: 345–354.Google Scholar
Gaynor JW, Burch M, Dollery C, Sullivan ID, Deanfield JE, Elliott MJ. Repair of anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 1995; 59: 1472–1475.Google Scholar