Persistent left superior vena cava-An alternative feasible technique during Senning procedure

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Senning procedure, though rarely performed, remains a valuable surgical option for transposition of great arteries (TGA) in specific patient groups.
• Late presentation of TGA can involve complex anatomical variations, including regressed left ventricle or pulmonary hypertension, necessitating modified surgical approaches.
• Patients with bilateral superior vena cavae (SVC) present unique challenges for the Senning procedure, typically requiring complex modifications like coronary sinus cutback.

Purpose of the Study:

• To describe an alternative surgical technique for rerouting a persistent left SVC in patients undergoing the Senning procedure.
• To simplify the surgical management of TGA in patients with bilateral SVC, reducing operative complexity.

Main Methods:

• The study presents a modification of the Senning procedure for patients with bilateral SVC.
• The described technique involves reimplanting the persistent left SVC onto the left atrial appendage.
• This approach aims to facilitate the formation of the systemic atrium after atrial switch surgery.

Main Results:

• The proposed method offers a simplified approach to managing bilateral SVC in the context of the Senning procedure.
• Reimplantation of the left SVC onto the left atrial appendage potentially streamlines the creation of the posterior venous baffle.
• This modification addresses a specific subset of complex TGA cases, enhancing surgical feasibility.

Conclusions:

• The described technique provides an effective alternative for rerouting a persistent left SVC during the Senning procedure.
• This modification can simplify the surgical management of transposition of great arteries in patients with bilateral SVC.
• This approach may improve outcomes for a challenging subset of congenital heart disease patients.