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J Thorac Cardiovasc Surg 2008;136:329-334
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Sinus node dysfunction after repair of partial anomalous pulmonary venous connection

^a Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
^b Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
^c Department of Cardiovascular Surgery, Akashi Medical Center, Kobe, Japan

Received for publication September 7, 2007; revisions received November 7, 2007; accepted for publication December 7, 2007.

^_* Address for reprints: Hiroaki Takahashi, MD, Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. (Email: takahashi-cvs{at}hotmail.co.jp).

Objectives: Sinus node dysfunction is known as a major complication after repair of partial anomalous pulmonary venous connection. We retrospectively analyzed the results of the atrial wall flap technique compared with the results of patch repair or direct suturing in the intra-atrial tunnel technique.

Methods: Between 1991 and 2007, 23 patients (mean age, 6 years; range, 5 months–17 years) with partial anomalous pulmonary venous connection underwent surgical intervention. The right anomalous pulmonary veins drained to either the right atrium or superior vena cava in 8 and 15 patients, respectively. Patients were divided into 2 groups: group F (n = 14), who had repair with an atrial flap, and group N (n = 9), who had repair without an atrial flap. All patients had normal sinus rhythm preoperatively.

Results: No patients had signs of superior vena cava or pulmonary venous obstruction within a mean follow-up of 4.8 years. One patient in group F required pacemaker implantation. In the early postoperative period, sinus node dysfunction developed in 93% of group F and 44% of group N patients (P < .01) and was prolonged until discharge in 57% of group F and 0% of group N patients (P < .01). At the most recent clinical visit, sinus node dysfunction was identified in 50% of group F patients, whereas all patients in group N had normal sinus rhythm (P < .02).

Conclusions: The atrial flap technique, which requires incision or suture crossing the crista terminalis, could cause sinus node dysfunction, whereas the intra-atrial rerouting method with a patch or direct suture maintains normal sinus node function postoperatively.