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superior sinus Venosus Atrial septal Defect: Overview of surgical Options

Open Journal of Thoracic surgery 2013年第4期3卷 114-122页

作者： Kelechi Emmanuel Okonta Michael sanusi Cardiothoracic surgery Unit Department of Surgery Lagos State University Teaching Hospital Ikeja Lagos State Nigeria. Cardiothoracic surgery Unit Department of Surgery University of Port Harcourt Rivers State Nigeria

Background: superior sinus venosus atrial septal defect (sV-AsD) is an interatrial defect with partial anomalous pulmonary venous connection (PAPVC) draining into the right atrium. The principle for sV-AsD surgical repair involves redirecting the pulmonary venous blood back to the left atrium and closure of the atrial septal defect without compromising the adjoining structures. Methods: We reviewed English literature relating to this topic via a MEDLINE and Google scholar search using the following terms: surgery for sinus venosus atrial septal defect (sV-AsD), surgery for partial anomalous pulmonary venous connection (PAPVC) and complications of the surgery. Results: A total of 910 consecutive cohort patients with different surgical options between 1984 to 2012 were analyzed. The breakdown showed that 291(32.0%) had single-patch, 275(30.2%) had warden’s procedure, 185(20.3%) had a double-patch and 159(17.5%) had use of autologous right atrial appendage for the anastomosis. The total follow-up was between 0.008-30 years. sinus node dysfunction (sND) was the commonest complication occurring mostly in patients who had double-patch technique 16(8.6%) followed by 15(5.5%) patients with single-patch technique, 7(4.4%) patients in whom right atrial appendage was used and 5(1.8%) patients with warden’s procedure. Venous obstruction occurred in 22(7.7%) patients with sP, 13(5.1%) patients with warden’s Procedure and 5(2.7%) patients with double-patch. Conclusion: The two major complications, sND and venous obstruction, assumed a see-saw approach as surgical maneuvers avoiding venous obstruction encouraged sND and vice versa. However, adopting surgical options which avoided incision across the Cavoatrial junction attenuated all the complications.

关键词： sinus Venosus-Atrial septal Defect warden’s Procedure Right Atrial Appendage single-Patch Technique Double-Patch Technique

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