Totally Endoscopic Correction Of Partial Anomalous Pulmonary Venous Drainage With Atrial Septal Defect In An Elderly Patient
Tomoki Ushijima, Satoshi Fujita, Meikun Kan-o, Satoshi Kimura, Yasuhisa Oishi, Hiromichi Sonoda, Akira Shiose.
Kyushu University Hospital, Fukuoka, Japan.
BACKGROUND: Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital heart disease and represents a variety of subsets. Some are diagnosed in childhood, while others are often first diagnosed in adulthood. Minimally invasive cardiac surgery (MICS) is now performed for various types of cardiac lesions, and, for most adult and adolescent patients, a MICS approach is desirable as an alternative to median sternotomy if the anatomical conditions are acceptable. We here report a successful case of totally endoscopic correction of PAPVD with sinus venosus atrial septal defect (SV-ASD).
METHODS: A frail 81-year-old man presented with dyspnea on exertion. Echocardiography showed severely dilatated right atrium and ventricle with interatrial shunt and anomalous pulmonary venous return to the right atrium. Computed tomography revealed anomalous connection of the right upper pulmonary veins drained from the right upper and middle lobes to the superior vena cava-right atrial junction. We concluded that the MICS approach was feasible after sufficient anatomical assessments. All procedures were conducted under thoracoscopic field of view via a minithoracotomy along the fourth intercostal space with a small skin incision of 5 cm. Cardiopulmonary bypass was established with femoral arterial perfusion and peripheral bicaval venous drainage. After aortic clamping and induction of cardioplegic arrest, the right atrium was opened. Baffling orifices of the anomalous pulmonary veins across the SV-ASD with a bovine pericardium achieves correction of anomalous pulmonary venous drainage. Concomitantly, tricuspid annuloplasty for significant tricuspid regurgitation and left appendage clipping for chronic atrial fibrillation were performed through the same minithoracotomy.
RESULTS: Operation was uneventfully completed. Postoperative echocardiography showed no residual shunt and excellent pulmonary venous flow, and computed tomography demonstrated a widely patent baffle. Approximately one year after surgery, the patient was doing well with improved quality of life.
CONCLUSIONS: We performed a totally endoscopic correction of PAPVD. This strategy is a feasible optional approach based on sufficient anatomical assessments. 
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