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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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