Surgery for Partial Anomalous Pulmonary Venous Connections: Modification of the Warden Procedure with a Right Atrial Appendage Flap

BACKGROUND: Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications. METHODS: Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials. RESULTS: No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months). CONCLUSION: Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.

Transfromation of Percutaneous Extracorporeal Life Support to Paracorporeal Ventricular Assist Device: A Case Report

Percutaneous extracorporeal life support (P-ECLS) is a useful modality for the management of refractory cardiac or pulmonary failure. However, venoarterial P-ECLS may result in a complication of left ventricular distension. In this case report, we discuss a patient with drug-induced dilated cardiomyopathy managed with venoarterial P-ECLS and a left atrial vent catheter. The venoarterial P-ECLS was modified to a paracorporeal left ventricular assist device (LVAD) by removing the femoral venous cannula. After 28 days of hospitalization, the patient was successfully weaned from the paracorporeal LVAD and discharged home from the hospital.

Successful Management of Atrio-Esophageal Fistula after Cardiac Radiofrequency Catheter Ablation

An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation.