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Surgical techniques in partial anomalous pulmonary veins to the superior vena cava
S Y DeLeon1, J E Freeman, M N Ilbawi
1Department of Cardiovascular-Thoracic Surgery, Loyola University Medical Center, Maywood, IL 60153.
Insights
Surgical repair of partial anomalous pulmonary veins (PAPV) draining into the superior vena cava (SVC) is effective. Atriocavoplasty, a technique using the right atrial appendage (RAA) to enlarge the SVC, showed good results but may impact sinus node function.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Partial anomalous pulmonary veins (PAPV) draining into the superior vena cava (SVC) present a complex surgical challenge.
- Accurate surgical correction is crucial for long-term patient outcomes and preventing complications.
Purpose of the Study:
- To evaluate the efficacy of different surgical techniques for repairing PAPV draining into the SVC.
- To assess the outcomes and potential complications associated with atriocavoplasty and other methods.
Main Methods:
- A 12-year retrospective study of 40 patients undergoing PAPV repair with SVC drainage.
- Three surgical groups were analyzed: atriocavoplasty with SVC enlargement (Group I), right atriotomy without SVC enlargement (Group II), and SVC-RAA anastomosis (Group III).
- Associated cardiac defects were repaired concurrently in six patients.
Main Results:
- No early or late mortality was observed across all groups.
- Atriocavoplasty (Group I) effectively rerouted PAPV and enlarged the SVC, with 10% experiencing late sinus bradycardia.
- One patient in Group II developed SVC/PAPV obstruction, and one in Group III had intermittent heart block.
Conclusions:
- Atriocavoplasty is an effective method for PAPV repair and SVC enlargement.
- While effective, atriocavoplasty may increase the risk of sinus node dysfunction.
- Alternative techniques also demonstrated feasibility, with specific complications noted based on the method used.
Abstract:
Over a 12-year period, 40 patients underwent repair of partial anomalous pulmonary veins (PAPV) draining to the superior vena cava (SVC) proximal to the sinus node. Mean age was 6 +/- 2 years. In all patients, the SVC was cannulated superior to the PAPV, which were baffled with pericardium to left atrium. Six patients had associated defects repaired. In 18 patients (group I), an incision was made at the crest of the right atrial appendage (RAA) and extended upward through the sinus node and to the SVC. After rerouting of the PAPV, the SVC was enlarged using the RAA (atriocavoplasty). In 17 patients (group II), rerouting of the PAPV was accomplished through a right atriotomy. Superior vena caval enlargement was not done. Drainage of the PAPV was close to the right atrium in 14 patients (low) and to the azygos vein (high) in 3. In 5 patients (group III), an incision was made on the SVC and RAA sparing the sinus node. After rerouting of the PAPV, the RAA was anastomosed to the SVC (end to side), providing another outlet for SVC flow. There was no early or late death. Two patients (10%) in group I had late sinus bradycardia. Obstruction of the SVC and PAPV developed in 1 patient in group II with high drainage. Intermittent complete heart block developed in 1 patient in group III who also had ventricular septal defect repair. We conclude that atriocavoplasty is effective for rerouting of the PAPV and enlarging the SVC, but may predispose to sinus node disease.(ABSTRACT TRUNCATED AT 250 WORDS)