Partial Anomalous Pulmonary Venous Connection with Intact Atrial Septum: Early and Mid-Term Outcomes.

BACKGROUND: Partial anomalous pulmonary venous return (PAPVR) with intact atrial septum warrants greater understanding and evaluation in the literature.

METHODS: From January 1993 to December 2018, 293 patients with PAPVR underwent surgical repair. Of these, 45 patients (15.3%) had an intact atrial septum. The median (1st quartile, 3rd quartile) age was 36 (24-48) years. Direct reimplantation, intra cardiac baffling, and caval division (Warden) technique was used in 17 (38%), 15 (33%), and 13 (29%) patients, respectively. Descriptive statistics were used to assess the data and Kaplan Meier analysis was used to assess survival.

RESULTS: Anomalous veins were right-sided in 27 patients (60%), left-sided in 16 patients (36%) and bilateral in 2 patients (4%). The insertion sites were the superior vena cava (SVC) 23 (51%), innominate vein 12 (27%), inferior vena cava (IVC) 6 (13%), coronary sinus 2 (4%), right atrium 1 (2%) and unknown in 1 (2%). Scimitar syndrome was noted in 8 patients (18%). There was no postoperative mortality or residual defects. Post-operative echocardiography excluded any obstruction of pulmonary or systemic veins. Post-operative complications included atrial fibrillation in 9 patients (20%) and pneumothorax requiring chest tube in 5 patients (11%). Survival at 1, 5, and 10 years was 100%, 95%, and 95%. Two patients underwent pulmonary vein dilatation one at 3 years the other at 7 years.

CONCLUSIONS: Surgical repair of PAPVC with intact atrial septum can be performed with excellent early and mid-term outcomes. The overall incidence of mid-term systemic or pulmonary vein stenosis is low.