A 34-year-old woman with type II dyspnea was diagnosed by echocardiography for partial anomalous vein connection with sinus venosus atrial septal defect, confirmed by an MRI. A two-patch repair technique through a video-assisted minimally invasive approach (MICS) was performed with excellent results.
This video tutorial shows how the authors were able to repair this pathology through a MICS approach. Few videos of this MICS repair technique exist, and the authors believe that this tutorial is a helpful demonstration that even congenital pathologies may be solved through small incisions.
Introduction
Out of all septal atrial defects, 10% are represented by the sinus venosus type and are frequently associated with partial anomalous pulmonary venous connections (PAPVC) (1). The purpose of the procedure is to correct the pulmonary vein flow to the left atrium, however, the consequences of the surgery might be both the superior vena cava stenosis or the injury of the sinus node (SN), thus more frequently associated to the single patch technique or the double-patch technique respectively (2). There are few published articles in the literature about this congenital repair by the double-patch technique through a video-assisted minithoracotomy. The authors aim to show step-by-step how MICS can be performed easily for this congenital population.
Patient Presentation
A 34-year-old woman was delivered by another institution with dyspnea (NYHA II) and findings in the echocardiography (ETT) for septal atrial defect and left atrium enlargement. A new ETT was performed in the authors’ center where enlargement of both right and left atrium and a right superior pulmonary vein connecting to superior vena cava with sinus venosus atrial septal defect (SVASS). A left-to-side shunt was also observed. A magnetic resonance imaging (MRI) corroborated the partial anomalous pulmonary vein connection entering into the right atrium and the atrial septal defect as well. Pulmonary hypertension was mild to moderate. The patient was then submitted to minimally invasive surgery.
Surgical Technique Videos
A right minithoracotomy was performed in the 4th-5th intercostal space (ICS). Two accessory ports (5 mm) were used to insert the Chitwood aortic clamp (right 3rd intercostal space [ICS], midaxillary line) and video camera (right 4th ICS). A Mohr atrial retractor (Geister Medizintecknik GmBH, Tuttlingen, G...
This video tutorial shows how the authors were able to repair this pathology through a MICS approach. Few videos of this MICS repair technique exist, and the authors believe that this tutorial is a helpful demonstration that even congenital pathologies may be solved through small incisions.
Introduction
Out of all septal atrial defects, 10% are represented by the sinus venosus type and are frequently associated with partial anomalous pulmonary venous connections (PAPVC) (1). The purpose of the procedure is to correct the pulmonary vein flow to the left atrium, however, the consequences of the surgery might be both the superior vena cava stenosis or the injury of the sinus node (SN), thus more frequently associated to the single patch technique or the double-patch technique respectively (2). There are few published articles in the literature about this congenital repair by the double-patch technique through a video-assisted minithoracotomy. The authors aim to show step-by-step how MICS can be performed easily for this congenital population.
Patient Presentation
A 34-year-old woman was delivered by another institution with dyspnea (NYHA II) and findings in the echocardiography (ETT) for septal atrial defect and left atrium enlargement. A new ETT was performed in the authors’ center where enlargement of both right and left atrium and a right superior pulmonary vein connecting to superior vena cava with sinus venosus atrial septal defect (SVASS). A left-to-side shunt was also observed. A magnetic resonance imaging (MRI) corroborated the partial anomalous pulmonary vein connection entering into the right atrium and the atrial septal defect as well. Pulmonary hypertension was mild to moderate. The patient was then submitted to minimally invasive surgery.
Surgical Technique Videos
A right minithoracotomy was performed in the 4th-5th intercostal space (ICS). Two accessory ports (5 mm) were used to insert the Chitwood aortic clamp (right 3rd intercostal space [ICS], midaxillary line) and video camera (right 4th ICS). A Mohr atrial retractor (Geister Medizintecknik GmBH, Tuttlingen, G...