成人部分肺静脈還流異常に対する人工血管を用いたWarden変法

Modified Warden Procedure Using the Interposition Graft Technique for Partial Anomalous Pulmonary Vein Connection in an Adult

部分肺静脈還流異常（PAPVC）に対するWarden法による外科手術は，成人においても刺激伝導障害，体静脈および肺静脈狭窄の回避に有用な術式であるが，高位還流かつ右房，右心耳狭小例においては術式に工夫を要する．われわれは上大静脈（SVC）ルート作成に人工血管を用いたWarden変法を行い，良好な結果を得たので報告する．

A 29-year-old female experienced dyspnea after giving birth and was admitted to our hospital with a diagnosis of heart failure. Echocardiography did not detect the cause of heart failure. Computed tomography （CT） revealed an anomalous right upper pulmonary vein connection to the superior vena cava （SVC） with a superior sinus venosus atrial septal defect. In addition, her right atrium was not enlarged and had a small right atrial appendage. We performed a modified Warden procedure using the interposition graft technique for reconstruction of the SVC root. The postoperative course was uneventful without sinus node dysfunction. Postoperative CT showed no stenosis of the pulmonary vein or SVC root. This technique was a useful surgical strategy for partial anomalous pulmonary vein connection to the SVC in the presence of a small right atrial appendage.