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Warden Technique: Anomalous Pulmonary Venous Drainage

Monday, April 28, 2014

Partial anomalous pulmonary venous connections (PAPVC) are a very heterogeneous group of lesions, in which at least one pulmonary vein is draining into the systemic venous system. These congenital lesions are frequently associated with atrial septal defects (ASD), typically the sinus venous type of defect.The type of correction must be determined based on the site of drainage of these anomalous veins.

The authors present a case of 6-year-old child with an anomalous venous drainage from the superior and medial lung lobes to the superior vena cava, associated with a large ASD. This video demonstrates the authors’ preferred technique for repairing these congenital defects, using the warden technique. The authors believe that the warden technique is a safe and reproducible way to correct almost every case of anomalous drainage. In the long term, this type of repair may protect from rhythm disturbances and from venous pathway obstruction.


This video is available in the CTSNet China Resource Center for CTSNet users who are unable to view videos due to YouTube restrictions.

Comments

Very descriptive operative video. Where was the PAPVD murmur exactly heard? What were the criteria that led you into choosing the Warden procedure for the specific TAPVD case?
Thank you for your comments. A systolic murmur was heard in the pulmonary focus, which happened to be an overflow because the left to right shunt. The herein gradient was 25 mmHg. The Warden technique was choosed in this particular patient upon the findings of the MRI which clearly show quite a distance (2-3 cm) between the PAPVD and the right atrium. Nevertheless, we are quite happy with the two-patch technique either, for those patients with the PAPVD closer to the atrium. It seems sensible to be familiar with both techniques, in orden to select the proper one in every given case. Juan-Miguel Gil-Jaurena Chief Pediatric Cardiac Surgery Hospital Gregorio Marañón. Madrid. Spain
Great job! what's the best age for a child with sinus venous type of PAPVC associated with ASD to receive such kind of surgery? and was minimal axillary thoracotomy used in the vedio?
Thank you for your comment. This particular case was performed through mid-line sternotomy. I feel happy approaching such condition by sub-mammary crease in adolescent female patients and through right axillary incision in younger ones. ASD plus PAPVD can be corrected at any age and most patients are operated on around three to five years of age.
Thank you for your question. As Juan Miguel said i generally perfom the Warden procedure trough a median sternotomy, altough it can be safely performed trough an axilary approach. I would say that ideal age for this surgery would be around five years of age. Our group have experience with Warden procedure in newborns and adult pacients.
thanks Juan/Ramon for your kind replies, another question is that can child with PAPVC and ASD take regular vaccine immunization? does vaccine has any potential risk to increase his cardiac overload or cause myocarditis?

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