Comparative analysis of the treatment of partial anomalous pulmonary vein connection by double-patch method or Warden Technique / 中华胸心血管外科杂志

Objective:To compare the surgical and long-term follow-up results of partial anomalous pulmonary vein connection treated by double-patch method or Warden Technique.Methods:There were 33 cases of right pulmonary vein connected with the superior vena cava from May 2010 to May 2019 in our center treated by double-patch method or Warden technique. 21 cases were treated by double-patch method and 12 cases by Warden technique. Echocardiography and electrocardiogram were followed up regularly to observe the occurrence of arrhythmia, superior vena cava stenosis and pulmonary vein stenosis postoperatively.Results:All patients were discharged uneventfully, and were followed up for 1~8 years. In double-patch group, 2 cases with arrhythmia, 1 of whom was junctional arrhythmia which was automatically converted to sinus rhythm 1 day after surgery. The other had an early second degree atrioventricular block after surgery, and sinus rhythm was restored 3 days later with temporary pacemaker. 1 case had superior vena cava stenosis by echocardiography(PD 8 mmHg). No arrhythmia was found in long-term follow-up in Warden group. 2 cases had superior vena cava stenosis by echocardiography(PD 6 mmHg). Right pulmonary vein stenosis(PD 8 mmHg) was found in 1 case by echocardiography, no obvious aggravation was found in long-term follow-up.Conclusion:The double-patch method and Warden Technique are both safe and effective in the treatment of partial anomalous pulmonary venous connection.

A Case of Scimitar Syndrome in an Adult with an Atrial Septal Defect / 日本心臓血管外科学会雑誌

The patient was a 34-year-old woman who had been routinely monitored after receiving a childhood diagnosis of partial anomalous pulmonary venous connection, but unilaterally discontinued follow-up examinations after the age of 18. At 33 years of age, she was admitted to our hospital after a physical examination revealed an abnormal shadow on a chest X-ray. Transthoracic echocardiography detected an atrial septal defect (ASD), and contrast-enhanced computed tomography showed that the right lower pulmonary vein drained to the inferior vena cava. The patient was diagnosed with scimitar syndrome with ASD. Cardiac catheterization showed a pulmonary/systemic flow ratio (Qp/Qs) of 2.48 and a left-to-right shunt rate of 59.7%. Surgical treatment was deemed to be indicated. The right lower pulmonary vein was anastomosed to the anterolateral wall of the right atrium, and an intra-atrial baffle repair was performed from the orifice within the right atrium to the left atrium through the existing ASD using untreated fresh autologous pericardium. Two years after the operation, good blood flow was maintained within the baffle with no stenosis at the anastomotic site. This report describes a rare case of scimitar syndrome with ASD in an adult woman, and provides a review of the existing literature.

Severe Aortic Stenosis and Partial Anomalous Pulmonary Venous Connection in a Turner Syndrome Patient / 日本心臓血管外科学会雑誌

A 42-year-old woman with Turner syndrome was admitted to our hospital due to severe aortic stenosis. Transthoracic echocardiography demonstrated severe aortic stenosis with a bicuspid aortic valve. Enhanced computed tomography revealed that the left upper pulmonary vein connected to the innominate vein, and the ascending aorta was enlarged (maximum diameter of 41 mm). Surgical intervention was performed though median sternotomy with cardiopulmonary bypass. After achieving cardiac arrest by antegrade cardioplegia, we performed an anastomosis to connect the left upper pulmonary vein to the left atrial appendage. Then, aortic valve replacement was performed with an oblique aortotomy in the anterior segment of the ascending aorta. The aortic valve was a unicaspid aortic valve. Following completion of aortic valve replacement with a mechanical valve, reduction aortoplasty was performed on the ascending aorta. The postoperative course was uneventful.

The application of Warden series operation in partial anomalous pulmonary venous connection / 天津医药

@#To clarify the efficacy and safety of Warden series operation in partial anomalous pulmonary venous connection (PAPVC). Methods Six patients with PAPVC (pulmonary vein drainage to superior vena cava), who were treated in cardiac surgery of Tianjin Chest Hospital from January 2016 to March 2018, were included in this study. All 6 patients underwent Warden series operation, including 3 with Warden surgery and another 3 with modified Warden surgery. Two patients underwent modified Warden surgery were rebuilt by autologous pericardial patch and 1 cases were connected to the superior vena cava and the right atrium with Gor-Tax vessels. The echocardiography and electrocardiogram were reviewed regularly after operation (1 month, 3 months, 6 months and 1 year after operation，1 time a year for more than 1 year after the operation). The changes of cardiac structure, superior vena cava and pulmonary venous reflux and arrhythmia were observed. Results All patients were discharged successfully. The patients were followed up for 3 months to 2 years. No residual anomalous shunt was found in reexaminating echocardiography, and superior vena cava and pulmonary venous return were unobstructed. Electrocardiogram showed sinus rhythm and no obvious abnormality. Conclusion The application of Warden series operation in partial anomalous pulmonary venous connection is safe and effective.

Value of transthoracic echocardiography and cardiac multi-slice spiral computed tomography in the diagnosis of partial anomalous pulmonary venous connection in children / 中华实用儿科临床杂志

Objective To make a comparison of transthoracic echocardiography (TTE) and cardiac multi-slice spiral computed tomography (MSCT) in the diagnosis of partial anomalous pulmonary venous connection (PAPVC) in children.Methods One hundred and one patients admitted from February 2008 to April 2014 in Guangdong General Hospital primarily diagnosed with PAPVC with or without other congenital heart diseases were analyzed retrospectively,all the cases underwent routine TTE,which 74 cases underwent cardiac MSCT examination,and the TEE and cardiac MSCT diagnosis results were compared with final surgical findings,then the TTE and cardiac MSCT diagnosis accuracy was calculated.SPSS 13.0 software was used to analyze the data.Results All the patients underwent TTE examination,meanwhile,74 cases received cardiac MSCT examination.Ninety-three cases were confirmed by surgical findings,while 8 cases were misdiagnosed with PAPVC.Sixty-eight cases diagnosed by TTE coincided with surgical findings,and the diagnosis accuracy was 73.12％ (68/93 cases);65 cases diagnosed by cardiac MSCT coincided with surgical findings,and the diagnosis accuracy was 94.20％ (65/69 cases).Among the patients who received both TTE and cardiac MSCT examinations,66 cases were confirmed through final surgical operation,2 cases were mis-diagnosis,so the diagnosis accuracy was 97.06％ (66/68 cases).Conclusions In terms of the diagnosis accuracy of PAPVC,cardial MSCT examination is superior to TTE,as almost all of the cases could be diagnosed by TTE combined with cardial MSCT.In consideration of the acoustics window of children,apart from the conventional parasternal approach of detecting pulmonary veins,the importance of suprasternal and subcostal views should also be attached.

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.

Partial anomalous pulmonary venous connection with intact atrial septum in a child with ventricular septal defect: a case report / 소아과

Partial anomalous pulmonary vein connection (PAPVC) is a rare congenital abnormal cardiac defect involving the pulmonary veins draining into the right atrium (RA) directly or indirectly by venous connection. Ninety percent of PAPVCs are accompanied by atrial septal defect (ASD). To our knowledge, there is no previous report of PAPVC with ventricular septal defect (VSD) without ASD in Korea, and in this paper, we report the first such case. A 2-day-old girl was admitted into the Chonnam National University Hospital for evaluation of a cardiac murmur. An echocardiogram revealed perimembranous VSD without ASD. She underwent patch closure of the VSD at 5 months of age. Although the VSD was completely closed, she had persistent cardiomegaly with right ventricular volume overload, as revealed by echocardiography. Three years later, cardiac catheterization and chest computed tomography revealed a PAPVC, with the right upper pulmonary vein draining into the right SVC. Therefore, correction of the PAPVC was surgically performed at 3 years of age. We conclude that it is important to suspect PAPVC in patients with right ventricular volume overload, but without ASD.

Diagnosis of partial anomalous pulmonary venous connection with intact interatrial septum by transthoracic echocardiography / 西安交通大学学报(医学版)

Objective To explore the features of echocardiographic partial anomalous pulmonary venous connection (PAPVC) with intact interatrial septum. Methods Three patients with intact interatrial septum of PAPVC were examined by transthoracic echocardiography (TTE) using HP Sonos 5500 color Doppler machine. Imaging was performed at a frequency of 2～4 MHz, or 12 MHz. Results Accuracy of the diagnosis by TTE was 100 %. The patients had isolated PAPVC. The connection site was the coronary sinus in two, right atrium in one. There was a single anomalous connection vein in one patient, two in the others. Apparent right heart dilation was found in all the patients. Conclusion Unexplained right heart volume overload that was examined by TTE should have a high-degree suspicion for PAPVC. The origin site of pulmonary veins and their flow should be examined routinely. Transesophageal echocardiography (TEE) and TTE are complementary in the diagnosis.