Our experience in the surgical treatment of partial anomalous pulmonary vein connection using the Warden technique

• Artur R. Sharafutdinov
• Nikolaeva I.E.
• Plechev V.V.
• Onegov D.V.
• Tuguzbaev R.I.

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

References

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