Background: Minimally invasive approaches have become a feature of cardiac surgery. We compared the outcomes of atrial septal defect closure through either a right thoracotomy or a median sternotomy in adults. Methods: Patients who underwent atrial septal defect closure of ostium secundum defects through either a right thoracotomy (n = 14) or a median sternotomy (n = 7) were analyzed. The atrial septal defect was closed with cardiac arrest of the ascending aorta clamped under a cardiopulmonary bypass in both groups. Results: The preoperative characteristics of the two groups did not significantly differ. The durations of cardiopulmonary bypass and of cardiac arrest were significantly longer, but the amount of intraoperative blood loss was significantly lower, in the right thoracotomy than in the median sternotomy group. The early postoperative course did not significantly differ between the groups, whereas postoperative minor complications developed in three and two patients in the right thoracotomy and median sternotomy groups, respectively. Conclusion: The outcomes of atrial septal defect closure through a right thoracotomy and a median sternotomy were comparable, suggesting that right thoracotomy is a safe and effective alternative to median sternotomy for atrial septal defect closure in adults.
A 73-year-old man with a severely stenosed bicuspid valve and an aneurysm of the ascending aorta underwent valve and aortic surgery. Preoperative imaging revealed a single coronary artery arising from the right side of the sinus of Valsalva and a branch that perfused into the left side of the heart to pass through the front of the pulmonary artery. We replaced the aortic valve and ascending aorta, painstakingly avoiding damage to the coronary artery and obstruction of the sole coronary ostium.
BackgroundPartial anomalous pulmonary venous return is a rare congenital cardiac anomaly that usually involves the right pulmonary vein and an atrial septal defect. Isolated partial anomalous pulmonary venous return with an intact atrial septum is even rarer, and this condition is usually treated surgically in younger patients. We describe isolated partial anomalous pulmonary venous return in a 65-year-old woman who was treated by caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstruction of the superior vena cava using a prosthetic graft.Case presentationA 65-year-old Asian woman who presented with exertional dyspnea was diagnosed with isolated partial anomalous pulmonary venous return. The surgical indications and strategy were controversial because of the rarity of this pathology. She had an indication for surgery because she was symptomatic and had a high ratio of pulmonary to systemic blood flow. We considered that surgical procedures should avoid postoperative stenosis of a reconstructed flow tract, sinus node dysfunction, and thrombogenesis. We created a caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstructed the superior vena cava using a prosthetic graft for the isolated partial anomalous pulmonary venous return. She has since remained free of exertional dyspnea, arrhythmia, and thrombotic complications. This surgical strategy is safe and effective for treating isolated partial anomalous pulmonary venous return in older symptomatic adults.ConclusionsThe long-term outcome of surgical repair of partial anomalous pulmonary venous return with an intact atrial septum in our patient, a symptomatic 65-year-old woman, was excellent.
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