Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava—The Warden Procedure Robert A. Gustafson,

Slides:

Advertisements

Similar presentations

Shunji Sano, MD, Kozo Ishino, MD, Masaaki Kawada, MD, Osami Honjo, MD

Advertisements

Roger J.F. Baskett, MD, David B. Ross, MD

Sinus node dysfunction after partial anomalous pulmonary venous connection repair Carlo Pace Napoleone, MD, Elisabetta Mariucci, MD, Emanuela Angeli,

(A) A Sinus venous defect with partial anomalous pulmonary venous return. (B) The pulmonary veins are baffled to the left atrium with native pericardium.

The “Broken Ring” Sign in Magnetic Resonance Imaging of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava PAUL R. JULSRUD, M.D.,

Repair of Scimitar Syndrome

Cardiac Autotransplantation

The Syncardia Total Artificial Heart: Implantation Technique

Total Artificial Heart Replacement With 2 Centrifugal Blood Pumps

Senning Operation Jaroslav Stark

Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection Anand.

Sinus Venosus Atrial Septal Defect: Repair with an Intra-Superior Vena Cava Baffle Brian W. Duncan, MD Operative Techniques in Thoracic and Cardiovascular.

Repair of Unusual Types of Total Anomalous Pulmonary Veins

Total Anomalous Pulmonary Venous Connection

Marcin Zieliński, MD, PhD

Nicola Viola, MD, Christopher A. Caldarone, MD

Heterotopic Heart Transplantation: Technical Considerations

Surgical Unroofing for Anomalous Aortic Origin of Coronary Arteries

Operative Methods Used for Heart Transplantation in Complex Univentricular Heart Disease and Variations of Atrial Situs Jose Montalvo, MD, Leonard L.

The Aortic Translocation (Nikaidoh) Operation

Shunji Sano, MD, Kozo Ishino, MD, Masaaki Kawada, MD, Osami Honjo, MD

The Yasui Operation Kirk R. Kanter, MD

Pulmonary Valve Preservation Strategies for Tetralogy of Fallot Repair

Brian L. Reemtsen, MD, Vaughn A. Starnes, MD

Christopher W. Baird, MD, Joseph M. Forbess, MD

The Syncardia Total Artificial Heart: Implantation Technique

Modified Hemi-Fontan Procedure

Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, Yoshifumi Naka,

Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome

A technique for repair of partial anomalous pulmonary vein connection to the superior vena cava José Pedro da Silva, MD, Luciana da Fonseca da Silva,

Evolving Surgical Strategy for Sinus Venosus Atrial Septal Defect: Effect on Sinus Node Function and Late Venous Obstruction Robert D. Stewart, MD, Frédérique.

Right Ventricle to Pulmonary Artery Shunt

Anaesthetic implications of grown-up congenital heart disease

Repair of Supracardiac Total Anomalous Pulmonary Venous Return

Sitaram M. Emani, MD, Pedro J. del Nido, MD

Anatomic Repair of Recurrent Aortic Arch Obstruction

Hani K. Najm, MD, Christopher A

Fenestrated Fontan for Hypoplastic Left Heart Syndrome

Repair of Anomalous Coronary Artery From the Pulmonary Artery by Aortic Implantation Anthony Azakie, MD Operative Techniques in Thoracic and Cardiovascular.

Fenestrated Fontan Procedure

Extracardiac Conduit Total Cavopulmonary Anastomosis

Extracardiac Fontan With Direct Cavopulmonary Connections

Gurjyot Bajwa, MD, Iva Dostanic-Larson, MD, PhD, Richard A

One-Stage Repair and Unifocalization for Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries in Early Infancy

The Standard Maze-III Procedure

Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: Does it matter? Sameh M. Said, MD,

Mustard Operation William G. Williams

Surgical Approach to Left Ventricular Inflow Obstruction Due to Dilated Coronary Sinus Florentino J. Vargas, MD, Jorge Rozenbaum, MD, Ricardo Lopez, MD,

Gananjay G. Salve, MCh, Shreepal A. Jain, MD, Bhavesh M

Junaid H Khan, MD, Doff B McElhinney, MD, V

Absent Pulmonary Valve Repair

In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ali Dodge-Khatami, MD, PhD, Alexander Kadner,

Hemi-Fontan Procedure

Atrial Switch Operation in a Patient With Dextrocardia, Bilateral Superior Vena Cavae, Left Atrial Isomerism and Unroofed Coronary Sinus Sachin Talwar,

Transatrial and transmitral myectomy for hypertrophic obstructive cardiomyopathy of the left ventricle Hikaru Matsuda, MD Operative Techniques in Thoracic.

Repair of Infracardiac Total Anomalous Pulmonary Venous Return

Carl L. Backer, MD, Osama Eltayeb, MD, Michael C. Mongé, MD, John M

The standard maze-III procedure1 1 This article was previously published in Operative Techniques in Thoracic and Cardiovascular Surgery 5:2–22, 2000 (doi:

Stage I Norwood: The Birmingham Children’s Hospital Approach

“Lateral” Approach to Surgical Repair of Total Anomalous Pulmonary Venous Return Charles D. Fraser, MD Operative Techniques in Thoracic and Cardiovascular.

The Neonatal Arterial Switch Operation: How I Teach It

Intraatrial rerouting by atrial flaps for partial anomalous pulmonary venous return Satoru Okumura, MD, Masaaki Yamagishi, MD, Yutaka Kanki, MD, Norimichi.

Stage I—The Philadelphia Approach

Total Artificial Heart Replacement With 2 Centrifugal Blood Pumps

The multi–purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies Niv Ad, MD The Journal of Thoracic.

Extracardiac conduit fontan procedure without cardiopulmonary bypass

Transcaval Correction of Partial Anomalous Pulmonary Venous Drainage Into the Superior Vena Cava Mohamed Nassar, MD, Virginie Fouilloux, MD, Loïc Macé,

Repair of Anomalous Coronary Artery From the Pulmonary Artery by Aortic Implantation Anthony Azakie, MD Operative Techniques in Thoracic and Cardiovascular.

Repair of Infracardiac Total Anomalous Pulmonary Venous Return

Sinus node dysfunction after partial anomalous pulmonary venous connection repair Carlo Pace Napoleone, MD, Elisabetta Mariucci, MD, Emanuela Angeli,

Presentation transcript:

Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava—The Warden Procedure Robert A. Gustafson, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 11, Issue 1, Pages 22-32 (March 2006) DOI: 10.1053/j.optechstcvs.2006.03.001 Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 1 After a sternotomy incision, the pericardium is widely opened. The right superior vena cava is circumferentially dissected out from the SVC–right atrial junction to the SVC–bridging left innominate vein junction. If the right SVC is small, the presence of a left superior vena cava should be as suspected. Bulbous enlargement of the superior vena cava at the cavo-atrial junction suggests partial anomalous pulmonary venous connection. The anomalous right pulmonary veins draining into the superior vena cava are carefully dissected out. Entry into the right pleural space occasionally will improve visualization of the anomalous right pulmonary veins. The azygos vein is also circumferentially dissected out. Ao = aorta; IVC = inferior vena cava; MPA = main pulmonary artery; RA = right atrium; RV = right ventricle; SA = sinoatrial; SVC = superior vena cava. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 2 The azygos vein is doubly ligated and divided. Partial cardiopulmonary bypass is instituted after cannulation of the ascending aorta and the inferior vena cava. The superior vena cava cannula is inserted through the lateral wall of the right atrium and threaded into the right atrial appendage. The tip of the right atrial appendage is amputated and enlarged to the diameter of the cephalad superior vena cava. Complete excision of the trabeculae in the right atrial appendage enhances its expandability and reduces the risk of superior vena cava obstruction. Two vascular clamps are placed across the superior vena cava above the entrance of the highest anomalous right pulmonary vein. A transverse venotomy is made. SVC = superior vena cava. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 3 The superior vena cava cannula is threaded out the atrial appendage and inserted through the transverse incision in the superior vena cava. Full cardiopulmonary bypass is established. The caval transection is completed. The caudad superior vena cava stump is oversewn above the insertion of the highest anomalous right pulmonary vein. The cephalad superior vena cava stump is sewn to the amputated right atrial appendage with running 5-0 prolene suture. RA = right atrium; SVC = superior vena cava. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 4 Alternatively a venous cannula can be inserted directly into the high superior vena cava near the SVC–bridging left innominate vein junction. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 5 If there is a persistent left superior vena cava, a venous cannula is also inserted into the left SVC. SVC = superior vena cava. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 6 Hypothermic cardioplegic arrest is induced. A high right atriotomy exposes a sinus venosus atrial septal defect. Occasionally a small secundum ASD or PFO will also be present in the interatrial septum. The left-sided pulmonary veins should be identified returning into the left atrium. ASD = atrial septal defect; SA = sinoatrial. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 7 The anomalous right pulmonary venous return is directed across the sinus venosus atrial septal defect into the left atrium by coaptation of the free edge of the atrial septal defect to the atrial wall just above the intracardiac orifice of the superior vena cava. ASD = atrial septal defect. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 8 Alternatively a pericardial patch or a Gore-Tex patch can be used to redirect the anomalous pulmonary venous return into the left atrium. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 9 If an atrial septal defect is not present, a defect in the interatrial septum can be created near the usual location of a sinus venosus atrial septal defect. The anomalous right pulmonary venous return can then be redirected into the left atrium by either of the described techniques. ASD = atrial septal defect. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions

Figure 10 The right atriotomy is then closed. This technique avoids incisions or suture lines in the area of the sinus node or the sinus node artery. RPA = right pulmonary artery; SA = sinoatrial. Operative Techniques in Thoracic and Cardiovascular Surgery 2006 11, 22-32DOI: (10.1053/j.optechstcvs.2006.03.001) Copyright © 2006 Elsevier Inc. Terms and Conditions