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Year : 2013  |  Volume : 10  |  Issue : 2  |  Page : 68-71

Caval division technique and venous drainage after surgery for sinus venosus atrial septal defect

1 Department of Surgery, Division of Cardiothoracic Surgery, University of Port-Harcourt, PMB 5323, Port-Harcourt, Nigeria
2 Department of Cardiac Surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India

Correspondence Address:
Kelechi E Okonta
Department of Surgery, Division of Cardiothoracic Surgery, University of Port-Harcourt, PMB 5323, Port-Harcourt
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-7969.127003

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Bacgrounnd: The main reason for the adoption of the caval division technique is primarily to avoid sinus node dysfunction post-operatively. Equally, this technique also has the advantage of reduced complication of venous obstruction either across the superior vena cava right atrial (SVC-RA) appendage junction and/or pulmonary veins area. Objectives: To assess the impact of Caval Division Technique on venous drainage after surgery. Methods: The medical records for 38 consecutive patients who had a sinus venous atrial septal defect repair using the caval division technique from September 2009 to October 2011 were retrospectively reviewed and grouped into two: A total of 33 patients with normal intraoperative pressure across the anastomotic and venous areas (Group 1) and 5 patients with increased intraoperative venous pressure gradient across these areas (Group 2) with 1 patient in Group 2 having immediate surgical intervention. Results: The pressure across the cavoatrial anastomotic sites in 2 patients was 8 mmHg, in 2 patients was 6 mmHg and in 1 patient was 11 mmHg as indicated by the intraoperative pressure monitoring line and/or transesophageal echocardiograpy. However, the echocardiography performed at follow up showed no gradient across the SVC-RA appendage anastomotic site and there was no mortality recorded. Conclusion: In conclusion, the early operative impact of the caval division technique on venous drainage is of a good outcome and even when detected by intraoperative pressure line monitoring or transesophageal echocardiography, it can resolved spontaneous or attended to by additional band resections, especially in young children.

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