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Atsushi Nakahira
Toshikatsu Yagihara
Ikuo Hagino
Toru Ishizaka
Masahiro Koh
Hideki Uemura
Soichiro Kitamura
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Right arrow Congenital - acyanotic

Ann Thorac Surg 2006;82:978-982
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

Atsushi Nakahira, MDa, Toshikatsu Yagihara, MDa,*, Koji Kagisaki, MDa, Ikuo Hagino, MDa, Toru Ishizaka, MDa, Masahiro Koh, MDa, Hideki Uemura, MDb, Soichiro Kitamura, MDa

a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
b Department of Cardio-Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom

Accepted for publication February 4, 2006.

* Address correspondence to Dr Yagihara, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan (Email: yagihara{at}hsp.ncvc.go.jp).

BACKGROUND: Repair of partial anomalous pulmonary venous connection (PAPVC) to the high portion of the superior vena cava (SVC) may be complicated by atrial arrhythmia and obstruction of the pulmonary veins or SVC. We reviewed our experience with the modified Warden technique, in which the SVC was transected and anastomosed to the right atrial appendage with anterior augmentation of pedicled autologous pericardial flap, and the atrial septum was directly displaced to the SVC orifice.

METHODS: Twenty of 51 patients with PAPVC underwent this technique. Mean age was 11.9 years. Follow-up averaged 6.5 years. To quantify the height of insertion of anomalous pulmonary veins, the distance between the highest anomalous pulmonary venous orifice and SVC-right atrial junction was indexed by thoracic vertebral body height (height index).

RESULTS: All patients are alive in sinus rhythm. No patients exhibited pulmonary venous obstruction, and mean flow was 0.61 mL. Mean flow of SVC return was 0.79 mL. The SVC occlusion occurred in 2 patients who had persistent left SVC with a good communicating vein. Three patients whose height index exceeded 2.5 successfully underwent catheter intervention at the SVC channel.

CONCLUSIONS: Midterm results with the modified Warden technique were satisfactory. Patients with particularly high insertion of anomalous pulmonary veins should be treated and followed with specific caution for preserving an unobstructed caval pathway.




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