The trans-caval approach for surgical correction of sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage into the superior vena cava : Early experience in Alexandria University

Abstract

Many techniques have been developed to address the partial anomalous pulmonary venous drainage into the superior vena cava with or without sinus venosus atrial septal defect. The morphology of this anomaly is responsible for the possible surgical complications including sinus node dysfunction, systemic and/or pulmonary venous channels obstruction. Since early 2010, we started to slowly adopt the vertical trans-caval incision for the correction of this anomaly. Here, we present our early experience in Alexandria University with six patients operated using this approach. Between April 2010 and April 2011, six patients, aged between 7 and 35 years, were addressed using one patch of Gluteraldhyde prepared autologus pericardium, after vertical superior vena caval incision at the mouth of the anomalous pulmonary veins. Two patients had associated left superior vena cava. One patient required enlargement of the caval incision site by an additional patch. Follow up ranged from 2 to 12 months. There was no mortality or important morbidities. Post-operative echocardiographic examination of all patients showed unobstructed caval and pulmonary venous flow. Follow up ECG confirmed the absence of any arrhythmia. Vertical trans-caval approach is a highly reproducible technique for correction of partial anomalous pulmonary venous drainage into the superior vena cava with very low incidence of complications.