Background: Anatomy of bilateral superior vena cavae (SVC) without innominate vein could make it more complex to perform complete repair. We reviewed our cases of direct end-to-side anastmosis of SVCs to facilitate anatomical repair of SVC-right atrial connection for biventricular repair.
Methods: From July 2007 to December 2008, five patients received direct end-to side anastmosis of SVCs. Operative diagnosis are 2 partial atrioventricular septal defect with left isomerism, 1 complete atrioventricular septal defect with left isomerism, 1 complete atrioventricular septal defect without isomerism and 1 atrioventricular discordance and double outlet right ventricle with right isomerism. Mean age at the operation was 20±23 months (4-58) and body weight was 7.8±3.4 kg (4.8-12.7). Preoperative measurement of distance between SVCs by cardiac catheterization was 32.9±2.1 mm (30-35.5). After completion of intracardial repair, the SVC to left atrium was diveded at SVC-atrial junction. It was end-to side anastmosed to SVC to right atrium utilizing side-clamp during cardiopulmonary bypass. Postoperative anticoagulant was continued for 8 weeks after surgery.
Results: No early and late death occurred during follow-up of 8.4±6.9 months (1-17). All children had neither disturbed flow nor occlusion at the anastmosis site of SVCs by transthoracic UCG. One patient received postoperative cardiac catheterization, which demonstrated no pressure gradient between SVCs.
Conclusions: Direct end-to-side anastmosis of SVCs seems to be more advantageous technique in complex anomalies with bilateral SVCs compared to intraatrial rerouting. This technique achieved excellent anatomical SVC-RA connection repair in biventricular repair