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Minimally Invasive Patch Repair of Sinus Venosus Atrial Septal Defect
Ahmed Alnajar, Joseph Lamelas
University of Miami, Miami, FL, USA

OBJECTIVE: Atrial septal defect (ASD) is the most common anomaly in children and adults. Sinus venosus ASD account for 5-10% of cases. This video illustrates the minimally invasive technique of sinus venosus ASD repair with a superior vena cava (SVC) baffle and enlargement.
METHODS: The patient is a 58-year-old gentleman who presented for evaluation of sinus venosus ASD, which was found during a routine exam. In the operating room, the patient femoral vessels and subclavian vein were cannulated. Then, a right thoracotomy performed, cardiopulmonary bypass (CPB) instituted and the aorta was clamped. Atriotomy performed to extend the SVC into the right atrium. An SVC baffle created with a circular patch sutured within the SVC and over the anomalous right superior pulmonary vein, redirecting the blood to the left atrium. Subsequently, SVC and right atrium closed and enlarged withanother patch to avoid stenosis
RESULTS: Patient’s cross clamp and CPB times were 60 and 117 minutes, respectively. Intra-operative echocardiogram confirmed restored blood flow into the left atrium. He was discharged on post-operative day 3 in a good condition. On 30-day follow-up, the patient was alive and well.
CONCLUSIONS: Minimally invasive approach via right anterior thoracotomy for sinus venosus ASD repair is a safe surgery. Surgical repair for these cases can carry excellent outcomes should be performed carefully to avoid SVC stenosis.


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