Our experience in the surgical treatment of partial anomalous pulmonary vein connection using the Warden technique
Abstract
Aim. To evaluate the results of the correction of partial anomalous pulmonary
vein connection using the Warden technique.
Material and methods. A retrospective study of surgical treatment of 50 children with partial
anomalous pulmonary vein connection using the Warden technique and its
modifications was carried out. The age ranged from 4 months to 17 years,
weight from 4.5 to 66 kg. All patients underwent correction under
normothermic cardiopulmonary bypass through a median sternotomy. The
intracardiac stage was performed during the cardioplegia, anastomosis of the
SVC and the right atrial appendage was performed on beating heart with
parallel CPB. In 42 (84%) patients, the SVC was anastomosed directly into
the RA appendage. In 8 (16%) patients due to the high drainage of the
pulmonary veins into the SVC, the technique of "bridge" of the right
atrial appendage and an autopericardial patch was used.
Results. The postoperative period was uneventful in 49 patients. One patient, due to
SVC obstruction, required re-intervention on the next day. According to the
control examinations, the peak pressure gradient on the SVC was from 4 to
8 mm Hg, the average was from 2 to 4 mm Hg. and did not significantly
differ from the type of used anastomosis between the superior vena cava
and right atrium. Long-term results were carried out with a maximum
observation period of 7 years. In one patient, a narrowing of the SVC
anastomosis was revealed 6 months after the initial correction performed
at the age of 7 months. The anastomosis was reconstructed.
According to ECG and Holter ECG monitoring, sinus
rhythm was observed in 46 patients. Four patients had an atrial rhythm that did
not require the use of a pacemaker.
Conclusion. The use of the Warden technique for the correction of partial anomalous
pulmonary vein connection is a highly effective intervention, characterized by
a small number of possible complications.
Keywords:partial anomalous pulmonary venous connection, Warden procedure, superior vena cava stenosis, cardiac arrhythmias
Funding. The study had no sponsor support.
Conflict of interest. The authors
declare no conflict of interest.
For citation: Sharafutdinov A.R., Nikolaeva
I.E., Plechev V.V., Onegov D.V., Tuguzbaev R.I. Our experience in the surgical
treatment of partial anomalous pulmonary vein connection using the Warden
technique. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (3).
Supplement: 77-81. DOI: https://doi.org/10.33029/2308-1198-2021-9-3suppl-77-81 (in Russian)
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