Senning Procedure: Conceptualization in the Wet Lab

Training congenital heart surgeons today is challenging for themselves and their mentors. The situation becomes even more complicated while teaching complex surgical procedures. Senning operation is one of the most ingenious intracardiac techniques. We consider this surgical technique a worthy example to stand out the potential advantage of wet lab training. This article demonstrates the simulation of the Senning procedure in an explanted porcine model.

Keywords:
Animal Model; Congenital Heart Disease; Pediatric

Authorship

César Castillo Romero

Substantial contributions to the conception of the work

drafting the work

final approval of the version to be published

Department of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez, Mexico City, MexicoNational Institute of Cardiology Ignacio ChávezMexicoMexico City, MexicoDepartment of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico

Iris Pamela Flores Sarria

Substantial contributions to the acquisition of data for the work

drafting the work

final approval of the version to be published

Gabriella Ricciardi

Substantial contributions to the conception and design of the work

drafting the work

final approval of the version to be published

Department of Cardiac Surgery, University of Lille, Lille University Hospital, Lille, FranceUniversity of LilleFranceLille, FranceDepartment of Cardiac Surgery, University of Lille, Lille University Hospital, Lille, France

Jorge Luis Cervantes Salazar Correspondence Address: Jorge Luis Cervantes Salazar, https://orcid.org/0000-0002-5317-0527, Department of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez 1 Juan Badiano Street, Section 16, Tlalpan, Mexico City, Mexico Zip Code: 14080 E-mail: jorgeluis_cervantes@gmail.com

Substantial contributions to the conception of the work

revising the work

final approval of the version to be published

https://orcid.org/0000-0002-5317-0527

Correspondence Address: Jorge Luis Cervantes Salazar, https://orcid.org/0000-0002-5317-0527, Department of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez 1 Juan Badiano Street, Section 16, Tlalpan, Mexico City, Mexico Zip Code: 14080 E-mail: jorgeluis_cervantes@gmail.com

This study was carried out at the Department of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.

No conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (6)
Tables (1)

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Fig. 1
(A) Dissection of interatrial groove and right atrial initial incision. Dotted lines indicate the site of the first incision. (B) Localization of limbic tissue. The asterisk indicates fossa ovalis; the dotted lines, incision to create the atrial septal flap; and the arrow, coronary sinus. (C) Creation of atrial septal flap. Dotted lines indicate the site where the flap will be sutured; the arrow, left pulmonary veins; and the star, the flap extended with a bovine pericardium patch. CT=crista terminalis; IVC=inferior vena cava; RA=right atrium; RIPV=right inferior pulmonary vein; RSPV=right superior pulmonary vein.

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Video 1
This clip shows the procedure’s initial steps: dissection of Waterston’s groove, right atriotomy, and preparation for the first flap. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart1.mp4

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Video 2
Creation of atrial septal flap. The flap was sutured between the left pulmonary veins and the left atrial appendage. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart2.mp4

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Fig. 2
(A) Atrial septal flap sutured. Asterisk indicates the flap sutured between the left pulmonary veins and the left atrial appendage. (B) Enlargement of the left atrium and systemic venous pathway completed. The asterisk indicates second flap suture; the star, left atrium and right pulmonary veins enlarged; arrows, the new pulmonary venous course; points A and B´, augmentation incisions and suture sites for each increased flap extremity; and dotted lines, the area where the anterior wall of the right atrium will be sutured. (C) Reconstruction of pulmonary venous atrium. The red arrow indicates the coping of edges of the right pulmonary veins to the pericardial reflection; the asterisk, left atrium; dotted lines, the suture line site for the third flap; and the black arrow, the new pulmonary venous pathway. CT=crista terminalis; IVC=inferior vena cava; RA=right atrium; SVC=superior vena cava.

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Video 3
This clip shows the enlargement of the left atrium and a new systemic venous pathway, the reconstruction pulmonary venous atrium, the coping of edges of the right pulmonary veins to the pericardial reflection, and the final aspect after the procedure. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart3.mp4

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Fig. 3
(A) Final aspect after the procedure. The arrow indicates the suture line of the last flap. (B) Schematic drawings of the Senning procedure. Upper panel shows the shift (red arrows 1, 2, and 3) of flaps toward the structures in which they will suture them. In the lower panel, the cross-sectional view shows the intracardiac tunnels and systemic and pulmonary pathways (black arrows). IAS=interatrial septum; IVC=inferior vena cava; LA=left atrium; LIPV=left inferior pulmonary vein; lp=lower part; LSPV=left superior pulmonary vein; RAAW=right atrial anterior wall; RALW=right atrial lateral wall; RIPV=right inferior pulmonary vein; RSPV=right superior pulmonary vein; SVC=superior vena cava; tp=top part.

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Abbreviations, Acronyms & Symbols CS = Coronary sinus CT = Crista terminalis IAS = Interatrial septum IVC = Inferior vena cava LA = Left atrium LIPV = Left inferior pulmonary vein lp = Lower part LSPV = Left superior pulmonary vein RA = Right atrium RAAW = Right atrial anterior wall RALW = Right atrial lateral wall RIPV = Right inferior pulmonary vein RPV = Right pulmonary vein RSPV = Right superior pulmonary vein SVC = Superior vena cava tp = Top part

Fig. 1 (A) Dissection of interatrial groove and right atrial initial incision. Dotted lines indicate the site of the first incision. (B) Localization of limbic tissue. The asterisk indicates fossa ovalis; the dotted lines, incision to create the atrial septal flap; and the arrow, coronary sinus. (C) Creation of atrial septal flap. Dotted lines indicate the site where the flap will be sutured; the arrow, left pulmonary veins; and the star, the flap extended with a bovine pericardium patch. CT=crista terminalis; IVC=inferior vena cava; RA=right atrium; RIPV=right inferior pulmonary vein; RSPV=right superior pulmonary vein.

Video 1 This clip shows the procedure’s initial steps: dissection of Waterston’s groove, right atriotomy, and preparation for the first flap. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart1.mp4

Video 2 Creation of atrial septal flap. The flap was sutured between the left pulmonary veins and the left atrial appendage. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart2.mp4

Fig. 2 (A) Atrial septal flap sutured. Asterisk indicates the flap sutured between the left pulmonary veins and the left atrial appendage. (B) Enlargement of the left atrium and systemic venous pathway completed. The asterisk indicates second flap suture; the star, left atrium and right pulmonary veins enlarged; arrows, the new pulmonary venous course; points A and B´, augmentation incisions and suture sites for each increased flap extremity; and dotted lines, the area where the anterior wall of the right atrium will be sutured. (C) Reconstruction of pulmonary venous atrium. The red arrow indicates the coping of edges of the right pulmonary veins to the pericardial reflection; the asterisk, left atrium; dotted lines, the suture line site for the third flap; and the black arrow, the new pulmonary venous pathway. CT=crista terminalis; IVC=inferior vena cava; RA=right atrium; SVC=superior vena cava.

Video 3 This clip shows the enlargement of the left atrium and a new systemic venous pathway, the reconstruction pulmonary venous atrium, the coping of edges of the right pulmonary veins to the pericardial reflection, and the final aspect after the procedure. Link: https://s3.sa-east-1.amazonaws.com/publisher.gn1.com.br/bjcvs.org/videos/e20230025VideoPart3.mp4

Fig. 3 (A) Final aspect after the procedure. The arrow indicates the suture line of the last flap. (B) Schematic drawings of the Senning procedure. Upper panel shows the shift (red arrows 1, 2, and 3) of flaps toward the structures in which they will suture them. In the lower panel, the cross-sectional view shows the intracardiac tunnels and systemic and pulmonary pathways (black arrows). IAS=interatrial septum; IVC=inferior vena cava; LA=left atrium; LIPV=left inferior pulmonary vein; lp=lower part; LSPV=left superior pulmonary vein; RAAW=right atrial anterior wall; RALW=right atrial lateral wall; RIPV=right inferior pulmonary vein; RSPV=right superior pulmonary vein; SVC=superior vena cava; tp=top part.

Abbreviations, Acronyms & Symbols
CS	= Coronary sinus
CT	= Crista terminalis
IAS	= Interatrial septum
IVC	= Inferior vena cava
LA	= Left atrium
LIPV	= Left inferior pulmonary vein
lp	= Lower part
LSPV	= Left superior pulmonary vein
RA	= Right atrium
RAAW	= Right atrial anterior wall
RALW	= Right atrial lateral wall
RIPV	= Right inferior pulmonary vein
RPV	= Right pulmonary vein
RSPV	= Right superior pulmonary vein
SVC	= Superior vena cava
tp	= Top part

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Senning Procedure: Conceptualization in the Wet Lab

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[1] Correspondence Address: Jorge Luis Cervantes Salazar, https://orcid.org/0000-0002-5317-0527, Department of Congenital Heart Surgery, National Institute of Cardiology Ignacio Chávez 1 Juan Badiano Street, Section 16, Tlalpan, Mexico City, Mexico Zip Code: 14080 E-mail: jorgeluis_cervantes@gmail.com