Korean J Thorac Cardiovasc Surg.  2014 Apr;47(2):94-99.

Surgery for Partial Anomalous Pulmonary Venous Connections: Modification of the Warden Procedure with a Right Atrial Appendage Flap

• Kim C
• Cho YH
• Lee M
• Yang JH
• Jun TG
• Song JY
• Huh J
• Kang IS

Abstract

BACKGROUND
Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications.
METHODS
Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials.
RESULTS
No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months).
CONCLUSION
Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.

Keyword

Congenital heart disease (CHD); Partial anomalous pulmonary venous connection (PAPVC); Modified Warden procedure

MeSH Terms

Arrhythmias, Cardiac
Atrial Appendage*
Follow-Up Studies
Heart Septal Defects, Atrial
Humans
Reoperation
Sick Sinus Syndrome
Vena Cava, Superior