Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Science and Technology, Medical College, Trivandrum 695011, Kerala, India.
Eur J Cardiothorac Surg. 2011 Mar;39(3):388-91. doi: 10.1016/j.ejcts.2010.06.036. Epub 2010 Aug 8.
Repair of anomalous pulmonary venous connection (APVC) to superior vena cava (SVC) with internal pericardial patch may be complicated by the obstruction of the SVC or pulmonary veins and sinus node dysfunction. Moreover, the shrinkage of the pericardium may lead to late obstruction. Various techniques are practiced, which have reduced the incidence of obstruction to the venous drainage, but sinus node dysfunction continues to be an issue. We reviewed our experience with the Warden technique, predominantly in children, for various types of APVC to the SVC.
Between 2006 and 2010, 32 patients with anomalous drainage of the pulmonary veins to SVC underwent repair by the Warden technique in our institute. The median age at operation was 4 years (range 3 months-34 years). Partial anomalous pulmonary venous connection (PAPVC) was present in 28 patients, while four patients had total anomalous pulmonary venous connection (TAPVC) to the SVC, where one or more pulmonary veins joined the SVC separately from the entry of the common chamber. Clinical data, echocardiography and operative details were collected from our database, retrospectively.
At a median follow-up of 24 months, there was no mortality. One patient had transient rhythm disturbance. On follow-up, it was revealed that all patients are in sinus rhythm with no evidence of systemic or pulmonary venous obstruction.
The Warden technique is a simple and effective surgical option, which should be preferred for patients with anomalous drainage of the pulmonary veins to SVC. Though arrhythmias are rare in the early follow-up, longer follow-up is required to rule out their late development.
使用心包内补片修复异常肺静脉连接（APVC）至上腔静脉（SVC）可能会导致 SVC 或肺静脉阻塞和窦房结功能障碍。此外，心包的收缩可能导致晚期阻塞。各种技术的应用已经降低了静脉引流阻塞的发生率，但窦房结功能障碍仍然是一个问题。我们回顾了我们使用 Warden 技术治疗各种类型的 SVC 异常肺静脉引流的经验，主要是在儿童中。
2006 年至 2010 年间，我们医院对 32 例肺静脉异常引流至 SVC 的患者采用 Warden 技术进行修复。手术时的中位年龄为 4 岁（3 个月至 34 岁）。28 例存在部分异常肺静脉连接（PAPVC），4 例存在完全异常肺静脉连接（TAPVC）至 SVC，其中一条或多条肺静脉分别从共同腔入口连接至 SVC。从我们的数据库中回顾性收集了临床数据、超声心动图和手术细节。
在中位随访 24 个月时，无死亡病例。1 例患者出现短暂性节律紊乱。随访发现所有患者均为窦性心律，无全身或肺静脉阻塞证据。
Warden 技术是一种简单有效的手术选择，对于肺静脉异常引流至 SVC 的患者应优先考虑。尽管早期随访中心律失常罕见，但需要更长时间的随访以排除其晚期发生。
