1. Evolving Surgical Strategy for Sinus Venosus Atrial Septal Defect: Effect on Sinus Node Function and Late Venous Obstruction 
Robert D. Stewart, MD, Frédérique Bailliard, MD, Angela M. Kelle, BS, Carl L. Backer, MD, Luciana Young, MD, Constantine Mavroudis, MD 
The Annals of Thoracic Surgery 
Volume 84, Issue 5, Pages (November 2007)
DOI: /j.athoracsur
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Details of the Warden technique. High cannulation of the superior vena cava (SVC) is performed with a right-angle cannula with division of the SVC immediately above the partial anomalous pulmonary venous connections to save proximal SVC length. A pericardial patch is used to patch the cardiac orifice of the SVC to prevent stenosis or obstruction of the pulmonary venous return. (SA = sinoatrial).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
The right atrial appendage is opened with an incision in the tip, and care is taken to excise all trabeculations to avoid late stenosis. The completed pericardial patch on the superior vena cava is shown.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
The sinus venosus atrial septal defect is not “closed” but is used as an orifice through which the superior vena cava is baffled to the left atrium. The partial anomalous pulmonary venous connection blood flow goes through the remnant of superior vena cava through the sinus venosus atrial septal defect to the left atrium.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
The cut superior vena cava is anastomosed to the right atrial appendage using interrupted absorbable sutures to prevent pursestringing and to allow growth.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Comparison of preoperative to late electrocardiograms demonstrating a change from normal sinus rhythm (black bars) to a low atrial rhythm or junctional rhythm. (White bars = sinus node dysfunction.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions