Anomalous pulmonary venous connection to superior vena cava: Warden technique

Abstract

The Warden technique is a simple and effective surgical option, which should be preferred for patients with anomalous drainage of the pulmonary veins to SVC. Though arrhythmias are rare in the early follow-up, longer follow-up is required to rule out their late development.

Impact of Warden's Procedure on the Sinus Rhythm: Our Experience

“…Although, the early problems of persistent PAPVC and residual ASD have largely been eliminated, problems with SVC stenosis, pulmonary vein stenosis and SA node dysfunction have been reported in many series [4,5]. The use of Warden's procedure has clearly avoided these problems [1].…”

“…Atrial arrhythmia, sick sinus syndrome and junctional rhythm are common complications after the surgical repair of PAPVC. To prevent these complications, injury and unnecessary traction on the sinus node and sinus node artery should be avoided and PAPVC repair through cavotomy without right atriotomy is an effective means of preventing these postoperative rhythm disturbances [4][5][6]. The atriotomy in Warden's procedure offers the best option as it does not extend across the cavoatrial junction, sinus node or its arterial supply.…”

“…There were no operative deaths and no late deaths. No patient developed sinus node dysfunction or obstruction to the SVC Other authors advocate preferential use of Warden's procedure in PAPVC as it avoids interfering with sinus node [2,4,7].…”

“…Conventional repair of PAPVC with high insertion of anomalous veins would require an extension SVC patch with the potential complication for distortion or obstruction of the pliable structures in this region as well as the difficulty in patch placement in high SVC and thus makes the internal patch method less attractive. Also, using the internal patch without SVC enlargement has In 1984, Warden and colleagues described the Warden's procedure to avoid SVC and/or pulmonary venous obstruction and sinus node dysfunction [3,4]. The unit adopted this technique since 2008 because of the ease in using it and freedom from afore mentioned complications.…”

Right partial anomalous pulmonary venous connection to the superior vena cava following the Warden procedure

“…This technique reconstructs the cavoatrial junction with an anterior patch in order to enlarge the anastomosis. Kottayil et al suggest taking antiplatelet medications for 3 months after the surgery. We believe that releasing the SVC as much as possible by dividing the azygos vein and by ligating all the collaterals near the bridging vein allows a better mobilization of the SVC to perform the anastomosis between the SVC and the RA without any tension to avoid any SVC stenosis.…”