Immediate and long-term results of correction of partial anomalous drainage of the right superior pulmonary veins into the superior vena cava

• Evgeniy A. Svyazov
• Egunov O.A.
• Kiselev V.O.
• Kozhanov R.S.
• Krivoshekov E.V.

Abstract

Aim. To compare the short-term and long-term results of the stated methods of correction of partial anomalous pulmonary venous return to the superior vena cava in patients aged 2 to l8 years. The study used the Warden procedure and its modification.

Material and methods. A prospective, non-randomized study that included 35 patients. These patients underwent a surgical correction according to the conventional warden procedure (n=17) and the modified warden procedure (n=18). The choice of a surgical correction method depended on the anatomical position of the right atrial appendage, the length of the superior vena cava and the innominate vein. In case when the lengths of the right atrial appendage and the superior vena cava were not sufficient to form an anastomosis, we used a U-shaped flap and an additional autopericardial patch to form an anastomosis in accordance with the technique of the proposed method.

Results. The initial parameters of velocity and gradient of the superior vena cava did not differ between the groups. In the group, where the modified Warden procedure was used, there was no significant dynamics of the peak and mean pressure gradient, brood flow velocity of the superior vena cava. This might be explained by the procedure technique. A U-shaped flap of the right atrial appendage is used in the procedure, which together with the distal end of the superior vena cava forms the lower wall of the anastomosis, and the autopericardial patch forms the upper wall. Thus' a wide-lumen anastomosis was constructed, which allowed a large volume of blood flow to pass through' thus minimizing the risk of developing a stenosis of the superior vena cava in the postoperative period. In the group, where the Warden procedure was used, there was an increase in the peak and mean pressure gradient of the anastomosis between the superior vena cava and the right atrial appendage. In 29.4% (n=5) of patients, a significant stenosis was observed at the anastomosis between the superior vena cava and the right atrial appendage.

Keywords:partial anomalous pulmonary veins connective, H. Warden procedure

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