The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein

Purpose:When there is partially anomalous pulmonary venous connection to the superior caval vein, intracardiac repair alone can result in obstruction. Although the Warden procedure involving translocation of the superior caval vein is commonly performed as an alternative to atriocavoplasty, follow-up of a larger number of patients in the modern era is lacking. We report and discuss the experience of a single institution with the Warden procedure for correction of partially anomalous pulmonary venous connection to the superior caval vein.Methods:Since 1995, all 16 patients presenting with partially anomalous pulmonary venous connection to the superior caval vein underwent the Warden procedure at a mean age of 7.1 ± 4.2 years, with a range from 0.2 to 14.3 years, and a mean weight of 24.7 ± 14.0 kg, with a range from 4.1 to 52.9 kg. There were 9 males and 7 females. In 8 patients, we performed 10 concomitant procedures, including closure of an atrial or ventricular septal defect in 7, and advancement of the aortic arch in the other.Results:There were no deaths, and only one episode of postoperative sinus bradycardia with intermittent junctional rhythm, which resolved spontaneously during temporary atrial pacing. All patients were discharged home in normal sinus rhythm at an average of 4.1 ± 2.2 days after the procedure, with a range from 2 to 10 days. All are currently in the first grade of the New York Heart Association up to 5.6 years postoperatively. There is currently no evidence of sinus nodal dysfunction, nor obstruction of the superior caval vein, in any patient.Conclusion:The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein produces excellent results, preserves the function of the sinus node, and should be routinely considered for the repair of this lesion.

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Partially Anomalous Pulmonary Venous Connection to Solitary and Persistent Left Superior Caval Vein in Usual Visceroatrial Arrangement

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117719861 ◽

2017 ◽

Vol 11 (4) ◽

pp. NP88-NP90

Author(s):

Anoop Ayyappan ◽

Arun Gopalakrishnan ◽

Kapilamoorthy Tirur Raman

Keyword(s):

Pulmonary Veins ◽

Caval Vein ◽

Superior Caval Vein ◽

The Right ◽

Anomalous Pulmonary Venous Connection

Although the occurrence of bilateral superior caval veins (SCVs) is not unusual, persistence of the left SCV with atretic right SCV is extremely uncommon in the setting of normal visceroatrial arrangement. We report such a case that was also associated with anomalous pulmonary venous connection of the right pulmonary veins to the solitary left SCV.

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Horseshoe lung associated with anomalous pulmonary venous connection without pulmonary hypoplasia

Cardiology in the Young ◽

10.1017/s1047951100011550 ◽

1995 ◽

Vol 5 (1) ◽

pp. 91-93 ◽

Cited By ~ 3

Author(s):

Antonio Corno ◽

Luca Rosti ◽

Ivan Machado

Keyword(s):

Ventricular Septal Defect ◽

Congenital Malformation ◽

Septal Defect ◽

Pulmonary Hypoplasia ◽

Caval Vein ◽

Superior Caval Vein ◽

Horseshoe Lung ◽

Anomalous Pulmonary Venous Connection

SummaryHorseshoe lung is an exceedingly rare congenital malformation, characterized by unilateral pulmonary hypoplasia together with a midline isthmus producing fusion of the tissues of the lower lobes. It is frequently associated with other cardiac and extracardiac anomalies. We report an infant with a variant of the horseshoe lung with partial anomalous venous connection of intracardiac type, ventricular septal defect, and persistent left superior caval vein. There was no pulmonary hypoplasia.

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Echocardiographic diagnosis of totally anomalous pulmonary venous connection to the azygos vein

Cardiology in the Young ◽

10.1017/s1047951100004984 ◽

1999 ◽

Vol 9 (3) ◽

pp. 305-309 ◽

Cited By ~ 4

Author(s):

Anna Maria Musolino ◽

Giuseppe Santoro ◽

Bruno Marino ◽

Roberto Formigari ◽

Paolo Guccione ◽

...

Keyword(s):

Venous Blood ◽

Azygos Vein ◽

Caval Vein ◽

Superior Caval Vein ◽

Heart Malformation ◽

Precise Diagnosis ◽

Right Pulmonary Artery ◽

The Right ◽

Anomalous Pulmonary Venous Connection ◽

Axis View

AbstractTotally anomalous pulmonary venous connection to the azygos vein is a rare congenital heart malformation in which all the pulmonary venous blood returns anomalously to the azygos vein. Among 111 consecutive patients with totally anomalous pulmonary venous connection undergoing surgical correction at our institution between June 1982 and September 1997, this malformation was present in seven cases. By echocardiography, using a subxyphoid short-axis view at the atrial level and a modified suprasternal sagittal view, the malformation was diagnosed when the pulmonary venous confluence was traced posteriorly and superiorly relative to the right pulmonary artery and right bronchus, finally reaching reach the superior caval vein. Totally anomalous pulmonary venous connection to the azygos vein was misdiagnosed in the first two patients, both by echocardiography and angiocardiography. In the subsequent five patients, a precise diagnosis was obtained by echocardiography. Echocardiography, therefore, can be considered an accurate diagnostic tool permitting recognition of totally anomalous pulmonary venous connection to the azygos vein, and permitting corrective surgery without recourse to catheterization and angiography.

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Absence of the right superior caval vein associated with disease of the sinus node

International Journal of Cardiology ◽

10.1016/0167-5273(92)90118-m ◽

1992 ◽

Vol 36 (1) ◽

pp. 115-117 ◽

Cited By ~ 6

Author(s):

Catina Bernardis ◽

Andrew Chatzis ◽

Tom Treasure

Keyword(s):

Sinus Node ◽

Caval Vein ◽

Superior Caval Vein ◽

The Right

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Totally anomalous pulmonary venous connection to superior caval vein after an intracytoplasmic injection of sperm

Cardiology in the Young ◽

10.1017/s1047951109991053 ◽

2009 ◽

Vol 19 (5) ◽

pp. 527-529

Author(s):

Javier Pérez-Lescure Picarzo ◽

David Crespo Marcos

Keyword(s):

Congenital Anomaly ◽

Assisted Reproductive Technology ◽

Right Atrium ◽

Pulmonary Veins ◽

Reproductive Technology ◽

Caval Vein ◽

Superior Caval Vein ◽

Intracytoplasmic Injection ◽

Anomalous Pulmonary Venous Connection

AbstractWe report the occurrence of non-obstructive totally anomalous pulmonary venous connection to the superior caval vein in a child conceived by intracytoplasmic injection of sperm, a type of assisted reproductive technology. Totally anomalous pulmonary venous connection is an uncommon congenital anomaly, in which all the pulmonary veins connect to the morphologically right atrium, or one of its tributaries. To our knowledge, this malformation has not been previously described in a child conceived on the basis of assisted reproductive technology.

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The Warden procedure for partial anomalous pulmonary venous connection in children: 10 years experience in 65 cases

Cardiology in the Young ◽

10.1017/s1047951120002516 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1486-1489

Author(s):

Hesham Alkady ◽

Ahmed Elnaggar ◽

Mahmoud Eldegwy ◽

Abdallah Nosair

Keyword(s):

Sinus Node ◽

Pulmonary Veins ◽

Sinus Node Dysfunction ◽

Long Term Results ◽

Age Group ◽

Caval Vein ◽

Superior Caval Vein ◽

Paediatric Age ◽

The Mean ◽

Low Incidence

AbstractIntroduction:In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years.Patients and methods:In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study.Results:In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) could be followed up for a mean period of 7.8 ± 1.2 years after discharge. During the follow-up period, no stenosis was detected in the Warden anastomosis or the rerouted pulmonary veins and only one case of late mortality (1.6%) occurred due to a non-cardiac cause.Conclusion:The Warden procedure is a safe approach for the repair of high PAPVCs (above the cavoatrial junction) in the paediatric age group with good long-term results and low incidence of complications like sinus node dysfunction as well as pulmonary vein and superior caval vein obstruction.

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Successful dilation of superior cavel venous obstruction following repair of totally anomalous pulmonary venous connection

Cardiology in the Young ◽

10.1017/s1047951100005928 ◽

1997 ◽

Vol 7 (1) ◽

pp. 88-90

Author(s):

S. Shrivastava ◽

S. Radhakrishnan ◽

Y. Vijaya Chandra

Keyword(s):

Balloon Dilation ◽

Venous Obstruction ◽

Caval Vein ◽

Superior Caval Vein ◽

Anomalous Pulmonary Venous Connection

AbstractWe describe post azygos obstruction of the superior caval vein following repair of a mixed variety of totally anomalous pulmonary venous connection. Balloon dilation was immediately successful, and has provided persistent relief at a follow-up of 20 months.

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