Long-Term Outcomes of the Double Barrel Technique forSuperior Sinus Venosus Defect with Partially AnomalousPulmonary Venous Connection
Srikant Sharma, Ujjwal Kumar Chowdhury, S Ramakrishnan, Priya Jagia
AIIMS, New Delhi, India
Background: Repair of superior sinus venosus defect atrial septal defect (ASD) with high partially anomalous pulmonary venous connection (PAPVC) using an intracardiac baffle may be complicated by systemic or pulmonary venous pathway obstruction and sinus nodal dysfunction (SND). Our surgical strategy for repair of superior sinus venosus defect has evolved chiefly to avoid the abovementioned complications and preserving the growth potential of the superior cavoatrial junction. Methods: Between 2007 and 2019, 50 consecutive patients aged 2-60 (mean,17.6Â±16.7) years underwent repair of superior sinus venosus defect ASD using the double barrel technique as described. The anomalous pulmonary veins drained into the superior cavoatrial junction in 17 patients and more than 2 cm above the cavoatrial junction in 33 patients. Results: There were no early or late deaths and no reoperations. At a mean follow-up of 103.9 (Â±50.2) months, all survived the operation and actuarial freedom from sinus nodal dysfunction was 97.9% (Â±SE, 0.02%; 95% CI: 0.86-0.99). No patient had systemic or pulmonary venous pathway obstruction. A permanent pacemaker was required in one patient (2%) for sick sinus syndrome. Conclusions: The double barrel method is an expedient, safe and effective technique in superior sinus venosus defect ASD. It provides dual drainage of SVC preserving the superior cavoatrial junction without causing systemic or pulmonary venous pathway obstruction and can be utilised in all cases including those with high PAPVC. Preservation of the cavoatrial junction and use of autogenous atrial tissue for systemic venous pathway avoids sinus nodal dysfunction and preserves growth potential.
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