Partial anomalous pulmonary venous connection to the superior vena cava: The outcome after the warden procedure

OBJECTIVE: Partial anomalous pulmonary venous connection (PAPVC) draining into the superior vena cava (SVC) has been repaired with various techniques. We investigated the outcome of the Warden procedure for repair of this anomaly. METHODS: From December 1994 to January 2011, 30 patients underwent a Warden procedure for repair of PAPVC to the SVC in our center. Their median age at the time of the operation was 4.9 years (range, 1 month to 55 years). Follow-up data were obtained through a review of medical records, correspondence with the patients' cardiologists, and direct telephone contact. The mean followup duration was 5.3 ± 5.1 years (range, 1 month to 16 years). RESULTS: One patient died of an underlying cardiac condition and cerebral complication unrelated to the Warden procedure. One patient had transient postoperative sinus node dysfunction. During follow-up, pulmonary venous pathway obstruction occurred in one patient, and systemic venous pathway obstruction occurred in three patients. Re-operation or re-intervention for systemic venous pathway obstruction was required in younger (<2 years) and smaller (<7 kg) patients within 1 year after the Warden procedure. All patients were in regular sinus rhythm in the latest electrocardiogram. CONCLUSIONS: The Warden procedure is a safe and effective surgical option for repair of PAPVC to the SVC in terms of preserving the sinus node function and non-obstructive pulmonary venous pathway. However, more attention must be paid to the reconstruction of non-obstructive systemic venous pathway, especially in younger and smaller children. Patch augmentation could be considered and effectively performed, if there is any doubt regarding tension-free anastomosis.