Abstract
Background: Partial anomalous pulmonary venous connection (PAPVC) accounts for 0.4-0.7% of congenital heart disease. Herein, we report a case of successful surgical treatment of PAPVC that preserves the specialized conduction system without any artificial materials.
Case presentation: A 21-year-old male patient had no significant medical history. The patient was referred to our department because the enlargement of right hilar shadow was shown on chest X-ray during a school physical examination. Partial anomalous pulmonary venous connection was diagnosed by contrast enhanced computed tomography. The right upper pulmonary vein was returning to the higher superior vena cava. The pulmonary systemic blood flow ratio was 2.88 on right heart catheterization. Surgery was performed under general anesthesia, with the patient in a supine position. An atrial septum defect was created under cardiac arrest using cardiopulmonary bypass as usual, and the rerouted right upper pulmonary vein blood flow using fresh autologous pericardial patch. An incision was made in the right atrial appendage and sutured to the superior vena cava for creating a pathway for blood flow from the superior vena cava to enter the right atrium (modified Warden procedure).
Postoperative CT scan revealed successful rerouting blood flow of right upper pulmonary vein and superior vena cava.
Superior vena cava-right atrium anastomosis, such as Warden procedure has the advantage of reducing the risk of postoperative sick sinus syndrome because not touching the sinus node. Reconstruction using only autologous tissue has advantages of antithrombogenicity. There are some case reports of an adult patient with using a fresh autologous pericardial patch who developed pulmonary vein obstruction in the remote term. Therefore, careful follow up is necessary in this case.
Conclusions: We performed a successful operation for repair of PAPVC connected to SVC with modified Warden procedure. The procedure was safe and simple and yielded excellent postoperative outcomes.
