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Evolving surgical strategy for sinus venosus atrial septal defect: effect on sinus node function and late venous
Robert D Stewart1, Frédérique Bailliard, Angela M Kelle
1Division of Cardiovascular Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA.
The Annals of Thoracic Surgery
|October 24, 2007
Summary
Surgical repair of sinus venosus atrial septal defect using autologous pericardium shows low stenosis rates. The two-patch technique increases sinus node dysfunction risk, favoring Warden or single-patch repairs for specific venous connections.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Surgical strategies for sinus venosus atrial septal defect (SVASD) repair have evolved to minimize sinus node dysfunction.
- Review of surgical outcomes for single-patch, two-patch, and Warden repairs for SVASD.
Purpose of the Study:
- To evaluate the long-term outcomes of different surgical techniques for SVASD repair.
- To compare the incidence of sinus node dysfunction and stenosis following various repair methods.
Main Methods:
- Retrospective review of 54 patients undergoing SVASD repair between 1990 and 2006.
- Analysis of surgical techniques: single-patch (24), two-patch (25), and Warden (5) repairs, all using autologous pericardium.
- Assessment of partial anomalous pulmonary venous connection (PAPVC) drainage patterns and follow-up via echocardiogram and electrocardiogram.
Main Results:
- No early or late deaths or reoperations were reported.
- No pulmonary vein stenosis occurred; SVC stenosis was observed in 5 patients (mild to severe).
- Sinus node dysfunction (rhythm change) was significantly higher with the two-patch technique (55%) compared to single-patch (24%) and Warden (0%) repairs.
Conclusions:
- Autologous pericardium repair of SVASD is associated with low rates of SVC and pulmonary vein stenosis.
- The two-patch technique is linked to a higher incidence of sinus node dysfunction.
- The Warden procedure is preferred for PAPVC draining into the SVC, while the single-patch technique is optimal for SVASD with PAPVC draining into the right atrium or right atrium-SVC junction.
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