Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage.

Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.