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DOI: 10.1055/s-0030-1269156
Surgical treatment of patients with sinus venosus defect and rightsided partial anomalous pulmonary venous connection: Long-term follow-up of sinus node dysfunction and caval obstruction
Objectives: The surgical technique for repair of a SVD with RA-PAPVC should rigorously avoid long term complications of sinus node dysfunction (SND) and superior vena cava (SVC) obstruction. We reviewed our single institutional experience with respect to single-patch, double-patch and modified Warden-repair.
Methods: Between 1964 and 2010, 64 consecutive patients (mean age 14.6 14.2 years, preoperatively all in sinus rhythm) underwent surgical treatment. 30 patients received a single-patch (G1), 23 patients a double-patch repair (G2), whereas in 11 patients with PAPVR to SVC preferably a modified Warden-repair technique (G3) was used. This modification consisted of a SVC-RA anastomosis by use of substantial biopericardialpatch augmentation. Follow-up by ECG, echocardiogram or even an invasive catheterization was available in 81.25% of all patients.
Results: There were no early, but two cardiac, non-surgery related late deaths at mean follow-up of 12.3 years. We also did not observe any pulmonary vein stenosis but 1 SVC stenosis (double-patch). New onset of nodal rhythm and complex SND were found with high incidence in those patients with extended incisions through cavoatrial junction (G1 25% vs. G2 29.4% vs. G3 9.1%).
Conclusions: The Warden-technique is used for definitive repair of SVD with a PAPVR to SVC. The use of a double-patch-technique should be avoided. The single-patch-technique remains the procedure of choice in morphologies where PAPVR enters directly into RA.