Sinus venosus atrial septal defect in adults: Surgical repair using partial thoracoscopic approach

L. Le Gloan , A. Mugniot , F. Wautot , P. Guérin
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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.

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成人静脉窦房间隔缺损:部分胸腔镜入路手术修复
成人房间隔缺损(ASD)的最佳治疗方案应由一个多学科的ACHD团队给出;右室负荷过重的最佳治疗方法是及时关闭,无论年龄大小。到目前为止,尽管有新的经皮静脉窦ASD闭合方法,手术仍然是金标准,在体外循环中通过正中胸骨切开术进行。方法微创心脏手术通过视频辅助右小开胸入路修复ASD提供了可能。我们报告了3例20岁、42岁和46岁的成人,1女2男,使用部分胸腔镜,结合小前开胸和胸腔镜。结果/预期结果我们为女性患者提供了一个网膜周围切口。3例患者均为静脉窦性ASD伴右心室增大。他们没有肺动脉高压,并且都有一条孤立的右上肺静脉与上腔静脉相连。无持续性左上腔静脉引流至冠状窦,无明显三尖瓣反流。所有ASD均通过双补片技术成功修复,通过在右胸壁上放置2个端口以允许手术器械插入和小开胸。体外循环平均时间188分钟,主动脉交叉夹持平均时间122分钟,手术平均时间242分钟。术后机械通气时间平均309分钟,ICU住院时间均小于24小时。2个月时未发现死亡、残余分流、中度三尖瓣反流或肺不张。结论/观点:部分胸腔镜入路是治疗成人静脉窦ASD的一种可行且安全的方法。此外,它似乎允许更少的疼痛和更好的美容效果,特别是在女性中,使用乳晕周围切口。
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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
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.
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