Transcaval Repair of High Sinus Venosus ASD-Can we Avoid a Warden Procedure?

A 29 year old man was found to have right bundle branch block in ECG during regular health check-up, and was diagnosed with SVC type of sinus venosus ASD with PAPVC of right upper and middle pulmonary veins. He refused surgery at that time and was kept under follow up. 1 year later, he developed dyspnea on exertion NYHA class 2 and was accepted for surgical repair. CT angiography was done before surgery which revealed high sinus venosus defect and possibility of Warden procedure was kept in mind. Warden procedure has good immediate and mid term outcomes with low incidence of SVC obstruction and SA node dysfunction.(1),(2)

We describe this technique of repair of SVC type of SV-ASD with an incision in SVC lateral to SA node and augmenting SVC with an autologous pericardial patch to avoid narrowing. A small patent foramen ovale was closed through same venotomy incision without any atriotomy. This technique is simple, reproducible, safe and can avoid many rhythm problems and luminal narrowing of pulmonary veins or superior vena cava.

References

1. Lin H, Yan J, Wang Q, Li S, Sun H, Zhang Y, Zhang L, Liu W. Outcomes of the Warden Procedure for Partial Anomalous Pulmonary Venous Drainage. Pediatr Cardiol. 2020 Jan;41(1):134-140. doi: 10.1007/s00246-019-02235-8. Epub 2019 Dec 6. PMID: 31811329.

2. Yong MS, Griffiths S, Robertson T, Brink J, d'Udekem Y, Brizard C, Konstantinov IE. Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children. Interact Cardiovasc Thorac Surg. 2018 Sep 1;27(3):422-426. doi: 10.1093/icvts/ivy097. PMID: 29584855.