Primary sutureless repair concomitant with the Warden procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Medical Imaging in Cardiology

Background:

• Supracardiac total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart defect where pulmonary veins do not connect normally to the left atrium.
• Darling classification type 1b involves drainage into a vertical vein near the superior vena cava, posing surgical challenges.
• Anatomical variations in pulmonary venous drainage and chamber location can complicate surgical repair.

Purpose of the Study:

• To describe the successful surgical management of a complex case of supracardiac TAPVC (Darling type 1b) in a neonate.
• To evaluate the efficacy of a primary sutureless repair combined with the Warden procedure for this specific anomaly.
• To assess the postoperative anatomical and hemodynamic outcomes using computed tomography.

Main Methods:

• Diagnosis was confirmed using computed tomography (CT) in a 2-month-old infant.
• Surgical intervention involved a primary sutureless repair technique.
• The Warden procedure was performed concomitantly to address the anomalous venous drainage.
• Postoperative CT scans were utilized for follow-up assessment.

Main Results:

• Successful primary sutureless repair and Warden procedure were achieved.
• Postoperative CT demonstrated unobstructed pulmonary venous pathways.
• Superior vena cava (SVC) routes remained unobstructed after surgery.
• A slight shrinkage of the vertical vein connecting the pulmonary veins was observed.

Conclusions:

• Primary sutureless repair combined with the Warden procedure is a viable and effective surgical option for supracardiac TAPVC (Darling type 1b) with complex venous anatomy.
• This approach ensures satisfactory postoperative pulmonary venous and SVC flow.
• Minimally invasive techniques may offer benefits in managing complex congenital heart anomalies.