静脈洞型心房中隔欠損を伴う成人部分肺静脈還流異常に対するWarden変法

Modified Warden Procedure for Correction of Partial Anomalous Pulmonary Venous Connection and Sinus Venosus Atrial Septal Defect in an Adult

部分肺静脈還流異常（PAPVC）の外科治療におけるWarden法1）は，刺激伝導障害と血流障害回避の点から優れた術式と考えられるが，高位のPAPVCでは上大静脈（SVC）遠位部と右心耳の直接吻合が困難な場合がある．われわれは，右房壁フラップを用いてSVC-右房間の血流路を作成するWarden変法を行い，良好な結果を得たので報告する．

A 32-year-old woman was referred to our hospital for the surgical indication of sinus venosus-type atrial septal defect. Preoperative computed tomography scan revealed that the right upper pulmonary vein returned to the high superior vena cava. We performed a modified Warden procedure using a pedicle flap of the right atrial appendage along with a fresh autologous pericardium. Her postoperative course was uneventful with no venous obstruction or sinus node dysfunction. This technique is a useful surgical option for a partial anomalous pulmonary venous connection especially in adults.