Robotic Assisted Repair Of Persistent Left Superior Vena Cava Draining In The Left Atrium
Robinson Poffo, Carlos E. Tossuniam, Paola K. Montanhesi, Gustavo Foronda, Cesar H. Nomura, Alisson P. Toschi, Renato B. Pope.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
OBJECTIVE: Persistent left superior vena cava (PLSVC) is the most common variation of the thoracic venous system. It results from failure of the left anterior cardinal vein to involute. The incidence is approximately 0,5% in the normal population and 5% in patients with congenital heart disease. PLSVC drains into the right atrium via the coronary synus in 80 to 90% of cases, and in the left atrium in the remaining cases. The innominate vein is absent in 65% of cases. This case report describes a new method for correction of PLSVC using robotic technology.
METHODS: Female, 32 years, with dyspnea at rest, important hepatomegaly, jugular vein stasis and mild peripheral edema. Transthoracic echocardiogram showed LSVC draining into the left atrium, presence of innominate vein with left-to-right shunt, pulmonary hyperflow, dilation of right atrium and right ventricle, anomalous dreinage of hemiazygos vein in the LSVC, normal sized left atrium and left ventricle, and good biventricular function. Computed Tomography Angiography with 3-D reconstruction was performed to plan the procedure. Robotic assisted surgery was performed with single-lung ventilation, using a 12-mm trocar in the third left intercostal space for the camera and three 8-mm trocars for robotic instruments. Cardiopulmonary bypass (CPB) was established via left femoral cannulation; CO2 was insufflated in the left hemithorax for dissection; LSVC and hemiazygos veins were closed using PTFE sutures; CPB was discontinued; femoral decannulation was performed; left hemithorax was drained, trocars were removed and ports were closed.
RESULTS: There were no complications during the procedure and no need for conversion to thoracotomy. Patient was extubated in the Intensive Care Unit after 36 hours, following resolution of acute pulmonary edema. Echocardiogram showed enlarged left atrium and good biventricular function. No major bleeding and no complications related to peripheral cannulation. Hospital discharge in the 4th postoperative day.
CONCLUSIONS: The use of robotic technology allowed an effective and optimized manipulation of cardiac structures with low hospital length of stay. Patient showed early recovery and return to social activities and excellent aesthetic result at short-term follow-up. Therefore, robotic assisted technique was a safe and effective option for the correction of PLSVC.
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