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J Thorac Cardiovasc Surg 2007;133:656-659
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection

Department of Pediatric Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Received for publication March 28, 2006; revisions received June 22, 2006; accepted for publication August 7, 2006.

^_* Reprint requests: Anand P. Iyer, MCh, Division of Pediatric and Congenital Heart Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India-695 011. (Email: anandcvts{at}hotmail.com).

Objective: The correction of sinus venosus atrial septal defect with a partial anomalous pulmonary venous connection to the superior vena cava has been associated with obstruction to the venous return and sinus node dysfunction. We present our follow-up of 2 approaches of managing the lesion and compare their postoperative results.

Methods: Forty patients underwent operation between March 1999 and January 2005, of whom 37 patients (aged 3-50 years) are on follow-up. These patients were divided into 2 groups: single-patch repair (group A, 18 patients) and double-patch repair (group B, 19 patients). Echocardiography and electrocardiography were performed 7 days after surgery and during the subsequent follow-up.

Results: The mean duration of follow-up was 22.56 months. There were no postoperative deaths or residual defects. Six patients in group A and 2 patients in group B had turbulence and a significant superior vena cava-right atrium pressure gradient of more than 6 mm Hg. Nine patients in group A had a significant gradient causing turbulence across the right superior pulmonary vein at the level of the patch, whereas no patients in group B had turbulence across the pulmonary vein. Four patients in group A and no patients in group B had postoperative rhythm abnormalities on late follow-up. There was no other complication.

Conclusions: Partial anomalous pulmonary venous connection can be safely managed with multiple techniques with low morbidity. The double-patch technique is technically reproducible and offers better results in terms of superior vena cava narrowing and gradient across the pulmonary vein without any increase in complications.