Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

Abstract

Objectives We explore midterm results after surgical treatment of partial anomalous pulmonary venous connection (PAPVC) to superior vena cava (SVC) in our institution.

Methods From 2008 to 2017, 78 patients underwent surgical repair for PAPVC to SVC. Patients were divided into three groups based on surgical techniques: Single-patch repair (n = 20, group A), double-patch repair (n = 31, group B), and Warden repair (n = 27, group C). Their median age was 1.9 years (range: 3 months–13.8 years); median weight was 11.4 kg (range: 4.4–39.7 kg). Clinical, electrocardiographic and echocardiographic were available for all patients.

Results There were no early or late mortality. The mean follow-up duration was 1.8 ± 2.1 years (range: 0.6 months to 8 years). No pulmonary venous obstruction occurred and no residual left-to-right shunts sustained during the follow-up. Reoperation for SVC obstruction was required: 1 (5.3%) in group A, 1 (3.2%) in group B, and 2 (7.4%) in group C (p = 0.78). Four patients (3 in group B, 1 in group C, p = 0.7) presented transient rhythm disturbance at discharge and one patient in group B remains nonsinus rhythm during follow-up. Pacemaker was not required in all patients.

Conclusion PAPVC to SVC can be safely managed by multiple techniques. Careful manipulation nearby sinus node must be emphasized during double-patch repair to prevent injury of sinus node. Obstruction of postoperative SVC stenosis should be paid attention to after Warden procedure. For young patients, operation should not be performed that early, but until preschool age.

Keywords

cardiac - pediatric - pulmonary arteries/veins - surgery - complications

• Reference

• 1 Cooley DA, Ellis Jr PR, Bellizi ME. Atrial septal defects of the sinus venosus type: surgical considerations. Dis Chest 1961; 39: 158-160
• 2 Herlong JR, Jaggers JJ, Ungerleider RM. Congenital Heart Surgery Nomenclature and Database Project: pulmonary venous anomalies. Ann Thorac Surg 2000; 69 (4, Suppl): S56-S69
• 3 Buz S, Alexi-Meskishvili V, Villavicencio-Lorini F. , et al. Analysis of arrhythmias after correction of partial anomalous pulmonary venous connection. Ann Thorac Surg 2009; 87 (02) 580-583
• 4 Said SM, Burkhart HM, Schaff HV. , et al. Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: does it matter?. J Thorac Cardiovasc Surg 2012; 143 (04) 896-903
• 5 Stewart RD, Bailliard F, Kelle AM, Backer CL, Young L, Mavroudis C. Evolving surgical strategy for sinus venosus atrial septal defect: effect on sinus node function and late venous obstruction. Ann Thorac Surg 2007; 84 (05) 1651-1655 , discussion 1655
• 6 Takahashi H, Oshima Y, Yoshida M, Yamaguchi M, Okada K, Okita Y. Sinus node dysfunction after repair of partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2008; 136 (02) 329-334
• 7 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 (06) 601-605
• 8 DiBardino DJ, McKenzie ED, Heinle JS, Su JT, Fraser Jr CD. The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein. Cardiol Young 2004; 14 (01) 64-67
• 9 Nakahira A, Yagihara T, Kagisaki K. , et al. Partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 2006; 82 (03) 978-982
• 10 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 (02) 261-265
• 11 Shahriari A, Rodefeld MD, Turrentine MW, Brown JW. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg 2006; 81 (01) 224-229 , discussion 229–230
• 12 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 (03) 980-984 , discussion 985
• 13 Friedli B, Guérin R, Davignon A, Fouron JC, Stanley P. Surgical treatment of partial anomalous pulmonary venous drainage. A long-term follow-up study. Circulation 1972; 45 (01) 159-170
• 14 Iyer AP, Somanrema K, Pathak S, Manjunath PY, Pradhan S, Krishnan S. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg 2007; 133 (03) 656-659
• 15 Pace Napoleone C, Mariucci E, Angeli E, Oppido G, Gargiulo GD. Sinus node dysfunction after partial anomalous pulmonary venous connection repair. J Thorac Cardiovasc Surg 2014; 147 (05) 1594-1598
• 16 Alsoufi B, Cai S, Van Arsdell GS, Williams WG, Caldarone CA, Coles JG. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. Ann Thorac Surg 2007; 84 (06) 2020-2026 , discussion 2020–2026
• 17 Hamilton JR, Brooks SG, Walker DR. Alternative technique for repair of sinus venosus atrial septal defect. Ann Thorac Surg 1991; 51 (01) 144-146
• 18 Gustafson RA, Warden HE, Murray GF. Partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg 1995; 60 (6, Suppl): S614-S617
• 19 Russell JL, LeBlanc JG, Deagle ML, Potts JE. Outcome following repair of sinus venosus atrial septal defects in children. Asian Cardiovasc Thorac Ann 2002; 10 (03) 231-234
• 20 Sojak V, Sagat M, Balazova E, Siman J. Outcomes after surgical repair of sinus venosus atrial septal defect in children. Bratisl Lek Listy 2008; 109 (05) 215-219
• 21 Glatz AC, McBride MG, Paridon SM. , et al. Long-term noninvasive arrhythmia assessment after surgical repair of sinus venosus atrial septal defect. Congenit Heart Dis 2010; 5 (02) 141-148
• 22 Agarwal V, Okonta KE, Abubakar U, Gichuhi S. Impact of Warden's procedure on the sinus rhythm: our experience. Heart Lung Circ 2011; 20 (11) 718-721
• 23 Kottayil BP, Dharan BS, Menon S. , et al. Anomalous pulmonary venous connection to superior vena cava: Warden technique. Eur J Cardiothorac Surg 2011; 39 (03) 388-391
• 24 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 (05) 1664-1670
• 25 Anderson KR, Ho SY, Anderson RH. Location and vascular supply of sinus node in human heart. Br Heart J 1979; 41 (01) 28-32
• 26 Jaschinski C, Cussigh C, Fonseca E, Bruckner T, Karck M, Loukanov T. A wide comparison of techniques for repair of PAPVCS: one institution's 20-year experience. Thorac Cardiovasc Surg 2019
• 27 Baron O, Roussel JC, Videcoq M, Guérin P, Gournay V, Lefevre M. Partial anomalous pulmonary venous connection: correction by intra-atrial baffle and cavo-atrial anastomosis. J Card Surg 2002; 17 (02) 166-169