Evolving Surgical Strategy for Sinus Venosus Atrial Septal Defect: Effect on Sinus Node Function and Late Venous Obstruction

Impact of Warden's Procedure on the Sinus Rhythm: Our Experience

“…Although, the early problems of persistent PAPVC and residual ASD have largely been eliminated, problems with SVC stenosis, pulmonary vein stenosis and SA node dysfunction have been reported in many series [4,5]. The use of Warden's procedure has clearly avoided these problems [1].…”

Lateral Cavoatriotomy for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

“…Therefore, authors generally recommend the Warden procedure to avoid sinus node dysfunction. 7,8) However in recent series transient sinus node dysfunction 9,10,11) and SVC stenosis 11,12) have been reported after Warden procedure. Park, et al have informed that deep stitches to the sinus node and its artery while reconstructing the pulmonary-venous pathway is the possible mechanism for transient sinus node dysfunction after Warden procedure.…”

“…15) Steward, et al have reported sinus arrhythmia incidence of 24% in a single patch group and 55% in a two-patch group. 7) Similarly, in a retrospective study including 119 patients with PAPVC to RA or to SVC repair, authors compared the two techniques in terms of postoperative arrhythmia. Arrhythmia was 54% in the extended cavoatrial incision group while it was 24% in the atrial incision group.…”

“…Previous studies reported that caval incision with a second patch is a risk factor for sinus arrhythmia. 7,8,15) In our study, cavoatrial incision closure with patch augmentation was performed only in 7 patients. Probably, a relatively rare use of a second patch might have prevented this complication in our patients.…”

“…The authors recommended that an incision through the cavoatrial junction must be avoided to preserve sinus node and its artery. 7,8) Our clinical choice of procedure for PAPVC repair is also lateral cavoatriotomy, including little modifications. The purpose of this retrospective study is to evaluate our experience with this incision technique.…”