Outcomes of the Warden Procedure for Partial Anomalous Pulmonary Venous Connection: A New Idea From a Single-Center Experience

Document Type : Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Partial anomalous pulmonary venous connection (PAPVC) is prevalently right-sided. The Warden procedure (WP) is performed for the repair of PAPVC when the anomalous right-sided pulmonary veins (PVs) connect to the superior vena cava (SVC) far from the SVC-right atrium (RA) junction. We aimed to describe the mid-term outcomes in the WP. Moreover, we compared the outcomes in double-SVC cases with those without left-sided superior vena cava (LSVC).
 
Methods: In this retrospective study, the medical records of 25 (52% female) patients who underwent the WP between 2009 and 2019 were evaluated. Baseline, perioperative, and follow-up data, including mortality, SVC and PV obstruction, the presence of single right-sided or double SVC, and sinoatrial (SA) node dysfunction, were recorded.
 
Results: The mean (± SD) follow-up time was 5.08 years (±2.59 y). No mortality, SVC or PV obstruction, and SA node dysfunction were noted. SVC-RA anastomotic site mild stenosis occurred in 2 patients. Fourteen of the 25 patients (56%) had double SVC. Subgroup analysis of 2 groups of LSVC positive and LSVC negative revealed mild SVC anastomosis site stenosis in 1/14 (7%) of LSVC-positive and 1/11 (9%) of LSVC-negative patients (P=1.00). SVC anastomotic site patch augmentation was necessary in 3 of the 14 (21%) cases of the LSVC-positive group and none of the LSVC-negative patients (P=0.23).
 
Conclusions: The WP was associated with satisfactory outcomes. This method is excellent in patients who have concurrent LSVC. Coincident double SVC anatomy could be a new indication for performing the WP in relatively high PAPVC. (Iranian Heart Journal 2022; 23(4): 6-12)

Keywords


  1. Alsoufi B, Cai S, Van Arsdell GS, Williams WG, Caldarone CA, Coles JG. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. The Annals of thoracic surgery. 2007; 84(6):2020-2026.
  2. Ahmed O, Maraj R, Rerkpattanapipat P, Yazdanfar S. An unusual case of bilateral partial anomalous pulmonary venous return. Chest. 1999;116(4):398S-398S.
  3. Zwetsch B, Wicky S, Meuli R, Schnyder P. Three-dimensional image reconstruction of partial anomalous pulmonary venous return to the superior vena cava. Chest. 1995;108(6):1743-1745.
  4. El-Kersh K, Homsy E, Daniels CJ, Smith JS. Partial anomalous pulmonary venous return: a case series with management approach. Respiratory medicine case reports. 2019;27:100833.
  5. Yong MS, Griffiths S, Robertson T, et al. Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children. Interactive CardioVascular and Thoracic Surgery. 2018;27(3):422-426.
  6. Warden HE, Gustafson RA, Tarnay TJ, Neal WA. An Alternative Method for Repair of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava. The Annals of thoracic surgery. 1984/12/01/ 1984;38(6):601-605. doi:https://doi.org/10.1016/S0003-4975(10)62317-X
  7. Lawrance K, Grimshaw V, Hoyle G, Hicks J, Nixon P, Wooler G. Surgical treatment of atrial septal defect and partial anomalous pulmonary venous drainage. The Journal of thoracic and cardiovascular surgery. 1962;43(5):622-633.
  8. Said SM, Burkhart HM, Schaff HV, et al. Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: does it matter? The Journal of thoracic and cardiovascular surgery. 2012;143(4):896-903.
  9. Hijii T, Fukushige J, Hara T. Diagnosis and management of partial anomalous pulmonary venous connection. Cardiology. 1998;89(2):148-151.
  10. DiBardino DJ, McKenzie ED, Heinle JS, Su JT, Fraser Jr CD. The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein. Cardiology in the Young. 2004;14(1):64.
  11. Gustafson RA, Warden HE, Murray GF. Partial anomalous pulmonary venous connection to the superior vena cava. The Annals of thoracic surgery. 1995;60:S614-S617.
  12. Lin H, Yan J, Wang Q, et al. Outcomes of the warden procedure for partial anomalous pulmonary venous drainage. Pediatric cardiology. 2020;41(1):134-140.
  13. Shahriari A, Rodefeld MD, Turrentine MW, Brown JW. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. The Annals of thoracic surgery. 2006;81(1):224-230.
  14. Zubritskiy A, Naberukhin Y, Arkhipov A, et al. Outcomes of double-patch and Warden techniques in patients with supracardiac partial anomalous pulmonary venous connection. Heart, Lung and Circulation. 2020;29(1):156-161.