{"title":"Sinus venosus atrial septal defect in adults: Surgical repair using partial thoracoscopic approach","authors":"L. Le Gloan , A. Mugniot , F. Wautot , P. Guérin","doi":"10.1016/j.acvdsp.2023.07.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>The decision regarding optimal treatment for </span>atrial septal defect<span> (ASD) in adults should be given by a multidisciplinary ACHD team; the best treatment in the presence of right ventricular overload is timely closure, irrespective of age. So far, despite new percutaneous approach for </span></span>sinus venosus<span> ASD closure, surgery remains gold standard, performed via a median sternotomy<span> on cardiopulmonary bypass.</span></span></p></div><div><h3>Methods</h3><p><span><span>Minimally invasive cardiac surgery offers the possibility to repair ASD with a video-assisted approach through a right mini </span>thoracotomy. We report the use of a partial thoracoscopic, combining a small anterior thoracotomy to </span>thoracoscopy in 3 adults of 20, 42 and 46 years old, 1 woman and 2 men.</p></div><div><h3>Results/Expected results</h3><p><span><span>Our female patient was offered a periaareolar incision<span><span>. All 3 patients had a sinus venosus ASD with right ventricular enlargement. They had no pulmonary hypertension and all had one isolated right superior pulmonary vein<span> connected to the superior vena cava. None had a </span></span>persistent left superior vena cava draining to the </span></span>coronary sinus<span> and none had significant tricuspid regurgitation. All ASD were successfully repaired with a two-patch technique, by means of 2 ports positioned on the right chest wall to allow the insertion of surgical instruments and a small thoracotomy. Mean time of cardiopulmonary bypass was 188</span></span> <!-->minutes, mean time of aortic cross-clamp was 122<!--> <!-->minutes and mean time of operation was 242<!--> <span>minutes. Post-operative mechanical ventilation duration averaged 309</span> <!-->minutes and the mean duration of ICU stay was less than 24<!--> <span>hours for all. No death, residual shunt, moderate tricuspid regurgitation or lung atelectasis was found at 2 months.</span></p></div><div><h3>Conclusion/Perspectives</h3><p>This partial thoracoscopic approach appears as a feasible and safe approach for surgical closure of sinus venosus ASD in adults. Furthermore, it seems to allow less pain and better cosmetic outcome, particularly in women, using a periareolar incision.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023002409","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
The decision regarding optimal treatment for atrial septal defect (ASD) in adults should be given by a multidisciplinary ACHD team; the best treatment in the presence of right ventricular overload is timely closure, irrespective of age. So far, despite new percutaneous approach for sinus venosus ASD closure, surgery remains gold standard, performed via a median sternotomy on cardiopulmonary bypass.
Methods
Minimally invasive cardiac surgery offers the possibility to repair ASD with a video-assisted approach through a right mini thoracotomy. We report the use of a partial thoracoscopic, combining a small anterior thoracotomy to thoracoscopy in 3 adults of 20, 42 and 46 years old, 1 woman and 2 men.
Results/Expected results
Our female patient was offered a periaareolar incision. All 3 patients had a sinus venosus ASD with right ventricular enlargement. They had no pulmonary hypertension and all had one isolated right superior pulmonary vein connected to the superior vena cava. None had a persistent left superior vena cava draining to the coronary sinus and none had significant tricuspid regurgitation. All ASD were successfully repaired with a two-patch technique, by means of 2 ports positioned on the right chest wall to allow the insertion of surgical instruments and a small thoracotomy. Mean time of cardiopulmonary bypass was 188 minutes, mean time of aortic cross-clamp was 122 minutes and mean time of operation was 242 minutes. Post-operative mechanical ventilation duration averaged 309 minutes and the mean duration of ICU stay was less than 24 hours for all. No death, residual shunt, moderate tricuspid regurgitation or lung atelectasis was found at 2 months.
Conclusion/Perspectives
This partial thoracoscopic approach appears as a feasible and safe approach for surgical closure of sinus venosus ASD in adults. Furthermore, it seems to allow less pain and better cosmetic outcome, particularly in women, using a periareolar incision.
期刊介绍:
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.