Vertical right axillary thoracotomy for a modified Warden procedure with a descending thoracic aortic homograft: Tips and pitfalls

The Warden procedure has been described for the repair of a partial anomalous pulmonary venous connection that is inserted high in the superior vena cava. One long-term concern remains, which is related to the narrowing of the superior vena caval anastomosis. In fully grown teenagers and adults, we have modified the procedure by using an interposition graft that consists of a descending thoracic aortic homograft. It usually matches the size of the superior vena cava and avoids the need for anticoagulation. We also insert the homograft into the free wall of the right atrium rather than into the atrial appendage. We present the technique in a 16-year-old girl through a vertical right axillary thoracotomy.