Sinus node dysfunction after repair of partial anomalous pulmonary venous connection.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Cardiac Electrophysiology

Background:

• Sinus node dysfunction is a significant complication following surgical repair of partial anomalous pulmonary venous connection (PAPVC).
• Different surgical techniques exist for intra-atrial repair of PAPVC, with varying impacts on sinus node function.

Purpose of the Study:

• To compare the incidence of sinus node dysfunction after PAPVC repair using the atrial wall flap technique versus intra-atrial tunnel techniques (patch repair or direct suturing).

Main Methods:

• A retrospective analysis of 23 pediatric patients (mean age 6 years) who underwent surgical repair for PAPVC between 1991 and 2007.
• Patients were divided into two groups: Group F (n=14) with atrial flap repair and Group N (n=9) without an atrial flap (intra-atrial tunnel technique).
• All patients had normal sinus rhythm preoperatively, with a mean follow-up of 4.8 years.

Main Results:

• No significant superior vena cava or pulmonary venous obstruction was observed in either group.
• Early postoperative sinus node dysfunction occurred in 93% of Group F versus 44% of Group N patients (P < .01).
• At the most recent follow-up, 50% of Group F patients had sinus node dysfunction, while all Group N patients maintained normal sinus rhythm (P < .02).

Conclusions:

• The atrial flap technique, involving incisions or sutures near the crista terminalis, is associated with a higher incidence of sinus node dysfunction after PAPVC repair.
• Intra-atrial rerouting methods, utilizing a patch or direct suture without an atrial flap, effectively preserve normal sinus node function postoperatively.