Induction of rat acute-phase proteins by interleukin 6 in vivo. Eur J Immunol 1988;18:717–721. 6. Nijsten MW, De Groot ER, ten Duis HJ, Klasen HJ, Hack CE, Aarden LA. Serum levels of Interleukin-6 and acute phase responses. Lancet 1987;2:921. 7. Van Snick J. Interleukin-6: an overview. Annu Rev Immunol 1990;8:253–78. 8. Engleman RM, Rousou JA, Flack JE III, Deaton DW, Kalfin R, Das DK. Influence of steroids on complement and cytokine generation after cardiopulmo- nary byass. Ann Thorac Surg 1995;60:801– 804. 9. McElhinney DB, Petrossian E, Reddy VM, Hanley FL. Extracardiac conduit Fontan procedure without cardiopulmonary bypass. Ann Thorac Surg 1998;66: 1826 –1828. 10. Okabe H, Nagata N, Kaneko Y, Kobayashi J, Kanemoto S, Takaoka T. Extracardiac cavopulmonary connection of Fontan procedure with autologous pedicled pericardium without cardiopulmonary bypass.J Thorac Cardiovasc Surg 1998;116:1073–1075. 11. 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Univentricular repair: early and midterm results. J Thorac Cardiovasc Surg 1995;110:1692–1701. 17. Stewart JM, Gewitz MH, Clark BJ, Seligman KP, Romano A, Zeballos GA, Chang A, Murdison K, Woolf PK, Norwood WI. The role of vasopressin and atrial natriuretic factor in postoperative fluid retention after the Fontan procedure. J Thorac Cardiovasc Surg 1991;102:821– 829. 18. Mainwaring RD, Lamberti JJ, Carter TL Jr, Moore JW, Nelson JC. Renin, angiotensin II, and the development of effusions following bidirectional Glenn and Fontan procedures. J Card Surg 1995;10:111–118. 19. Vaynblat M, Chiaverelli M, Anderson JE, Rao S, Nudel DB, Cunningham JN Jr. Pleural drainage after repair of tetralogy of Fallot. J Card Surg 1997;12:71–76. Paucity of Sinus Node Dysfunction Following Repair of Sinus Venosus Defects in Children Roxanne E. Walker, MD, John E. Mayer, MD, Mark E. Alexander, MD, Edward P. Walsh, MD, and Charles I. Berul, MD S inus venosus defects have been repaired with im- proving results over many years, 1–6 but there is relatively little information in pediatrics regarding outcome, particularly concerning cardiac rhythms. The incidence of sinus node dysfunction after repair of sinus venosus defects in children is not known, and some have hypothesized that signs of sinus node dys- function are present preoperatively. 7 Preoperative markers of sinus node dysfunction could be beneficial in decision making regarding postoperative arrhyth- mia management strategies or implantation of pace- maker leads at the time of repair of sinus venosus defects. Therefore, the purposes of this study were: (1) to determine the incidence and potential preoperative electrocardiographic markers of sinus node dysfunc- tion after repair of sinus venosus defects, and (2) to determine the morbidity associated with current-era surgical repair of sinus venosus defects in a pediatric population. ••• The hospital computer database was searched for all patients who underwent repair of sinus venosus defects at our institution from September 1988 to December 1998. The study group was limited to those with superior sinus venosus defect or a deficiency in the common wall between the superior vena cava and the right pulmonary veins 8 (Figure 1). This diagnosis was determined by echocardiography and confirmed in all patients at the time of surgery. Data reviewed for each patient included age at time of surgery, symptomatology, electrocardiograms, echocardiographic reports, surgical notes, progress notes during hospitalization, and outpatient clinic records. The electrocardiogram was evaluated at 3 time points: preoperatively, immediate postopera- tively, or during hospitalization, and late postopera- tively or the most recent electrocardiogram available for each patient. We utilized the criteria for sinus node dysfunction as outlined by Yabek et al. 9,10 These include inappropriate sinus bradycardia, sinus arrest, sinus node exit block, abnormal P-wave morphology, or bradytachyarrhythmias. Surgical variables re- viewed included the type of surgical repair, material used for the repair, caval cannulation technique, other procedures, total cardiopulmonary bypass time, aortic cross-clamp time, and intraoperative complications. Finally, the postoperative variables analyzed included arrhythmias, need for inotropes, other complications, length of hospital stay, and echocardiographic results. One of 3 surgical techniques based upon the sur- geon’s preference was utilized at our institution during this time period. These included simple patch baffle or patching of the deficiency between the superior vena cava and the right pulmonary veins, patch closure of septal defect with superior vena cava–right atrial junc- tion augmentation with a second patch, and the War- den procedure. The Warden procedure, initially de- scribed by Lewis 11 and first performed by Warden et al, 12 involves division of the superior vena cava and azygous vein superior to the entrance of the pulmo- nary veins. The cranial end of the superior vena cava is sewn to an incision made in the right atrial append- age. The cardiac end of the divided superior vena cava From the Department of Cardiology, Children’s Hospital, and the Department of Pediatrics, Harvard Medical School; and Department of Cardiac Surgery, Children’s Hospital; and Department of Surgery, Harvard Medical School, Boston, Massachusetts. Dr. Berul’s address is: Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. E-mail: berul@ cardio.tch.harvard.edu. Manuscript received September 14, 2000; revised manuscript received and accepted December 15, 2000. 1223 ©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matter The American Journal of Cardiology Vol. 87 May 15, 2001 PII S0002-9149(01)01504-1