BACKGROUND: Atrial septal defect(ASD) is one of the most common congenital cardiac diseases in adults. Ostium primum ASD consists about 15% of all ASDs and was nomenclatured as partial atrioventricular septal defect. It is typically associated with concomittant mitral and tricuspid valvular anomalies. This report outlines the successful closure of ostium primum ASD with the repair of a mitral cleft via a port-access minimally invasive procedure with right thoracotomy.
METHODS: A 26-year-old female patient was presented with exertional dyspnea and intermittent angina. She had no notable comorbidities. Transthoracic echocardiography(TTE) revealed a septum primum type ASD and a cleft at the anterior leaflet of the mitral valve with moderate mitral regurgitation.
RESULTS: The patient underwent minimally invasive cardiac surgery. The right jugular vein was cannulated for superior cava cannulation by cardiac anesthesiologists Left femoral artery and vein were used for peripheral cannulation because their diameters were better than right ones. An incision of 5 centimeters (cm) was made through 4th intercostal space, 2 cm below the right inframammary fold. A 3D-endoscope was placed in the 4th intercostal space at the level of the mid-axillary line. Right atriotomy was performed and an ASD of 3.1 cm was observed. An anterior mitral cleft at the A2 scallop was detected through the ASD, and it was successfully repaired with 5-0 prolene seperated sutures. Optimal coaptation of leaflets were achieved and there was no regurgitation with the saline test. The ASD was closed with a bovine pericardial patch, preserving the coronary sinus. Preoprative transeosophageal echocardiography and postoperative TTE revealed no complication. The patient was stayed in the cardiovascular ICU for one day and discharged on the 6th postoperative day. One-year follow-up of patient was uneventful.
CONCLUSIONS: Minimally invasive approaches are favorable and feasible for adult patients with congenital heart diseases. It has been proven that they provide a faster recovery, require less blood product usage and yield better cosmetic results compared to median sternotomy. The use of a 3D video-endoscope is beneficial for achieving best surgical exposure by providing enlarged stereoscopic vision, depth perception, visual acuity and spatial orientation.
