Surgery for Partial Anomalous Pulmonary Venous Connections: Modification of the Warden Procedure with a Right Atrial Appendage Flap

Kim, Chilsung; Cho, Yang Hyun; Lee, Mina; Yang, Ji-Hyuk; Jun, Tae-Gook; Song, June O.; Huh, June; Kang, I-Seok

doi:10.5090/kjtcs.2014.47.2.94

Cited by 18 publications

(17 citation statements)

References 13 publications

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“…Modifications to the classic technique have been reported such as using a pericardial patch for the closure of the cardiac end of the SVC or using a right atrial auricular flap for the SVC to right atrial connection. 2,3 These modifications are aimed at further reducing the risk of obstruction to the SVC pathway. Thus, variations in the anatomy sometimes necessitate modification of surgical technique to prevent complications.…”

Section: Discussionmentioning

confidence: 99%

Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection

Chery

Ramakrishnan

Cross

et al. 2020

World J Pediatr Congenit Heart Surg

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Surgical repair of right-sided partial anomalous pulmonary venous return (PAPVR) involves baffling the pulmonary vein across a naturally occurring or surgically created atrial septal defect without causing pulmonary venous or superior vena cava obstruction. A nine-year-old male presented to us with an unusual anatomical variant of right-sided partial anomalous pulmonary venous connection. The pulmonary veins draining the right upper and middle lobes connected to the azygous vein that drained in the usual fashion into the superior vena cava. The Warden operation was modified, with the use of femoral vein homograft, to avoid pulmonary venous obstruction.

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Section: Discussionmentioning

confidence: 99%

Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection

Chery

Ramakrishnan

Cross

et al. 2020

World J Pediatr Congenit Heart Surg

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“…We believe this is not a suitable method in pediatric cases due to requirement of anticoagulants and lack of growth potential of the graft. Kim et al 7 described use of a flap of the opened right atrial appendage as the posterior aspect of the SVC-RAA anastomosis, and the anterior wall of the neo SVC augmented with autologous pericardial/bovine pericardial patch.…”

Section: Discussionmentioning

confidence: 99%

Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage

Amboli

Ashtaputre

Kamath

et al. 2018

World J Pediatr Congenit Heart Surg

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Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.

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“…Anomalous right-sided PV drainage is by far the most common form of PAPVC, representing at least 90% of the cases. In these patients, the right upper and middle PVs are the most frequently involved, and they usually drain into the right atrium at the level of its lateral free wall, into the superior vena cava (SVC) or at the cavo-atrial junction (3). Left-sided PAPVC is less frequent (10%), and it features the drainage of one or more left PVs, directly or by means of an additional vertical vein, into the innominate vein, the coronary sinus or a persistent left SVC (4).…”

Section: Introductionmentioning

confidence: 99%

The impact of the superior cavo-atrial incision in children and adults.

Ait-Alì¹,

Ravaglioli²,

Festa³

et al. 2020

Preprint

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Background and aim of the study The single-and double-patch repairs are the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in pediatric and adult patients, focusing in particular on the occurrence of postoperative rhythm disturbances. Methods 115 patients (male: 63, 54.8%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. 80 patients (70.4%) underwent surgical repair in pediatric age (<16 years old), while 35 (29.6%) patients were operated in adulthood. 49 patients (42.6%) underwent single-patch repair and 65 patients (56.5%) underwent double-patch repair. In only one patient the Warden procedure was performed (0,9%). Median follow-up time was 52 months (IQ 15.1-113). Results The type of surgical technique didn't affect the overall incidence of all rhythm disturbances (41% in single patch group and 35% in double patch groups, p=0.5). At long-term follow-up, ectopic atrial rhythm, as expression of sinoatrial node disturbance, was however significantly more frequent in the pediatric population (32% pediatric group and 8% adult group, p=0.02). Conclusions The higher incidence of ectopic atrial rhythm in children is probably related to the closer relationship of the sinus node to the superior cavo-atrial incision, which makes iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavo-atrial junction should therefore be preferred for children undergoing partial anomalous pulmonary venous connection repair. The impact of the superior cavo-atrial incision in children and adults.

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Surgery for Partial Anomalous Pulmonary Venous Connections: Modification of the Warden Procedure with a Right Atrial Appendage Flap

Cited by 18 publications

References 13 publications

Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection

Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection

Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage

The impact of the superior cavo-atrial incision in children and adults.

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