Is Restrictive Atrial Septal Defect a Risk in Partial Anomalous Pulmonary Venous Drainage Repair?

Zhu, Jiaquan; Kotani, Yasuhiro; Chetan, Devin; Zhao, Lisa; Coles, John G.; Caldarone, Christopher A.; Arsdell, Glen S. Van; Honjo, Osami

doi:10.1016/j.athoracsur.2014.01.051

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…We retrospectively summarized clinical data collected from multiple international centers. [3][4][5]7,[10][11][12]14,[16][17][18][19][20][21][22][23][24] Analysis of these data was presented in ►Table 4. We can find that pulmonary stenosis occurred more in single-patch group from the data we summarized.…”

Section: Discussionmentioning

confidence: 99%

“…4,6,18,24 And some articles hold the opinion that creation or enlargement of the ASD will increase the risk of PV/SVC stenosis or sinus node injury. Zhu et al 24 reported 155 patients with intact or restricted atrial septum in which 34 patients undergone creation or superior enlargement of ASD. They found these patients had higher postoperative PV stenosis and subsequent reintervention.…”

Section: Discussionmentioning

confidence: 99%

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Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

Zhang

et al. 2019

Thorac cardiovasc Surg

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Objectives We explore midterm results after surgical treatment of partial anomalous pulmonary venous connection (PAPVC) to superior vena cava (SVC) in our institution. Methods From 2008 to 2017, 78 patients underwent surgical repair for PAPVC to SVC. Patients were divided into three groups based on surgical techniques: Single-patch repair (n = 20, group A), double-patch repair (n = 31, group B), and Warden repair (n = 27, group C). Their median age was 1.9 years (range: 3 months–13.8 years); median weight was 11.4 kg (range: 4.4–39.7 kg). Clinical, electrocardiographic and echocardiographic were available for all patients. Results There were no early or late mortality. The mean follow-up duration was 1.8 ± 2.1 years (range: 0.6 months to 8 years). No pulmonary venous obstruction occurred and no residual left-to-right shunts sustained during the follow-up. Reoperation for SVC obstruction was required: 1 (5.3%) in group A, 1 (3.2%) in group B, and 2 (7.4%) in group C (p = 0.78). Four patients (3 in group B, 1 in group C, p = 0.7) presented transient rhythm disturbance at discharge and one patient in group B remains nonsinus rhythm during follow-up. Pacemaker was not required in all patients. Conclusion PAPVC to SVC can be safely managed by multiple techniques. Careful manipulation nearby sinus node must be emphasized during double-patch repair to prevent injury of sinus node. Obstruction of postoperative SVC stenosis should be paid attention to after Warden procedure. For young patients, operation should not be performed that early, but until preschool age.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

Zhang

et al. 2019

Thorac cardiovasc Surg

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“…Zhu et al [ 14 ] reported the outcomes of the Warden procedure with an ASD enlargement procedure, which was indicated when an intact atrial septum was present or the size of the ASD was smaller than the orifice of the abnormal pulmonary vein. Pulmonary venous tract stenosis requiring surgical reintervention occurred in 2 cases in their report [ 14 ]. In their study, degenerative thickening of the pericardial baffle patch was the main mechanism of pulmonary venous tract stenosis.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Warden Procedure for Anomalous Pulmonary Venous Return to the Superior Vena Cava: A 17-Year Experience

et al. 2022

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Background Surgical repair of partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) using the Warden procedure has favorable outcomes. However, there remain some concerns after the Warden procedure, such as sinoatrial nodal dysfunction and systemic or pulmonary venous stenosis. We investigated the outcomes of the Warden procedure for repair of PAPVR to the SVC. Methods This retrospective study included 22 consecutive patients who underwent the Warden procedure for PAPVR between 2002 and 2018. The median age and body weight at operation were 27.5 months (interquartile range [IQR], 5.0–56.8 months) and 13.2 kg (IQR, 6.5–16.0 kg), respectively. The median follow-up duration was 6.2 years (IQR, 3.5–11.6 years). Results There were no cases of early or late mortality. No patients had postoperative heart rhythm problems, except 1 patient who showed transient sinoatrial nodal dysfunction in the immediate postoperative period. Procedure-related complications requiring reintervention occurred in 5 patients, including 3 of 4 SVC stenosis cases and 2 pulmonary venous stenosis cases during follow-up. The rate of freedom from reintervention related to the Warden procedure was 75.9% at 10 years. Conclusion In cases requiring extension or creation of an atrial septal defect to achieve a sufficient venous pathway, or interposition of an entire circumferential conduit between the SVC and right atrium due to the shortness of the SVC in the Warden procedure, stenotic complications of the venous pathway occurred. Careful observation of changes in the pressure gradient or anatomical stenosis is required in such patients.

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“…The sinus venosus atrial septal defect should be enlarged if found to be small and restrictive at the time of repair in order to avoid such complication. 12 Some surgeons recommend, in addition, routine patch closure of the superior caval stump. 13 Nevertheless, we found, by time, that there is no statistically significant difference in the post-operative gradients across the pulmonary veins with or without patch augmentation of the superior caval stump and therefore omitted this step to save more time for other steps.…”

Section: Discussionmentioning

confidence: 99%

The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

et al. 2020

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Introduction: In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years. Patients and methods: In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study. Results: In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) could be followed up for a mean period of 7.8 ± 1.2 years after discharge. During the follow-up period, no stenosis was detected in the Warden anastomosis or the rerouted pulmonary veins and only one case of late mortality (1.6%) occurred due to a non-cardiac cause. Conclusion: The Warden procedure is a safe approach for the repair of high PAPVCs (above the cavoatrial junction) in the paediatric age group with good long-term results and low incidence of complications like sinus node dysfunction as well as pulmonary vein and superior caval vein obstruction.

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Is Restrictive Atrial Septal Defect a Risk in Partial Anomalous Pulmonary Venous Drainage Repair?

Cited by 3 publications

References 22 publications

Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

Outcomes of the Warden Procedure for Anomalous Pulmonary Venous Return to the Superior Vena Cava: A 17-Year Experience

The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

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