Commentary: Robotic repair of a sinus venosus atrial septal defect in an adult patient: A technical stunt or a preview of things to come?

Abstract Background Brain abscess is a common complication in children with cyanotic congenital heart disease. The presence of an underlying acyanotic congenital heart disease is usually not suspected in an adult patient presenting with brain abscess. Case summary A 51-year-old male patient with no known co-morbidities came with complaints of recent onset right lower limb weakness needing support while walking and on evaluation was found to have brain abscess. He underwent robotic endoscope assisted endoport excision of the brain abscess. Two-dimensional transthoracic echocardiography showed right atrial and right ventricular dilatation with mild low-pressure tricuspid regurgitation. Transoesophageal echocardiography (TOE) revealed sinus venosus atrial septal defect (ASD) with left-to-right shunt with the right upper pulmonary vein draining into superior vena cava. Contrast echocardiography revealed a small transient right-to-left shunt. He has been advised to undergo elective surgical closure of ASD with partial anomalous pulmonary venous connection repair. Discussion Right-to-left shunting in ASDs can occur in the early systole even in the absence of raised pressures in the right side of the heart, even when the predominant shunt is left to right, but the magnitude of such a shunt is small and transient and is easily missed. Contrast echocardiography and TOE should be done as a part of evaluation of patients presenting with brain abscess.

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Single-Patch Fold-Back Technique for Augmentation of the Superior Vena Cava in Sinus Venosus Atrial Septal Defect Associated with Partial Anomalous Pulmonary Venous Return

The Heart Surgery Forum ◽

10.1532/hsf98.2014433 ◽

2015 ◽

Vol 17 (6) ◽

pp. 282

Author(s):

Suguru Ohira ◽

Kiyoshi Doi ◽

Takeshi Nakamura ◽

Hitoshi Yaku

Keyword(s):

Atrial Septal Defect ◽

Superior Vena Cava ◽

Septal Defect ◽

Venous Return ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Sinus Venosus ◽

Right Atrial ◽

Anomalous Pulmonary Venous Return

Sinus venosus atrial septal defect (ASD) is usually associated with partial anomalous pulmonary venous return (PAPVR) of the right pulmonary veins to the superior vena cava (SVC), or to the SVC-right atrial junction. Standard procedure for repair of this defect is a patch roofing of the sinus venosus ASD and rerouting of pulmonary veins. However, the presence of SVC stenosis is a complication of this technique, and SVC augmentation is necessary in some cases. We present a simple technique for concomitant closure of sinus venosus ASD associated with PAPVR and augmentation of the SVC with a single autologous pericardial patch.

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Percutaneous Treatment of Congenital Defects of the Inter-atrial Septum in Adults – Recent Advances and Persistent Pitfalls

Interventional Cardiology Review ◽

10.15420/icr.2009.4.1.76 ◽

2009 ◽

Vol 4 (1) ◽

pp. 76

Author(s):

James Slater ◽

Mark Fisch ◽

◽

Keyword(s):

Atrial Septal Defect ◽

Adult Patient ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Percutaneous Treatment ◽

Atrial Septum ◽

Congenital Defects ◽

Foramen Ovale ◽

Anatomy And Physiology ◽

Specific Tissue

William Harvey was the first scientist to describe the heart as consisting of separate right- and left-sided circulations. Our understanding of the heart’s anatomy and physiology has grown significantly since this landmark discovery in 1628. Today, we recognise not only the importance of these separate systems, but also the specific tissue that divides them. Our growing understanding of the inter-atrial septum has allowed us to identify defects within this structure and develop effective percutaneous devices for closure of these defects in the adult patient. This article discusses the formation of a patent foramen ovale (PFO) and atrial septal defect (ASD). In addition, we describe the medical illnesses caused by these defects and summarise the indications and risks related to percutaneous closure of these defects. We also report the most up-to-date transcatheter therapeutic options for closure of these common congenital defects in the adult patient.

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