Anomalous left hepatic vein to coronary sinus in a patient with atrial septal defect : Minimally invasive approach ; Technical challenges

Left hepatic vein draining into coronary sinus is a rare systemic vascular anomaly. Its presence is significant when it is associated with other cardiac lesions requiring surgery. We report technical challenges in a case of persistent left superior vena cava and left hepatic vein draining into coronary sinus in an adult with ostium secundum atrial septal defect, which was repaired through minimally invasive approach. Main technical challenge in this case was to achieve adequate venous drainage, which was achieved by vacuum assistance and by manipulating the position of femoral venous cannula. We approached through right anterolateral thoracotomy, adequate venous drainage was achieved without cannulating left hepatic vein or left superior vena cav.

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Anomalous left hepatic vein to coronary sinus in a patient with atrial septal defect: Minimally invasive approach; technical challenges

Journal of Cardiac Surgery ◽

10.1111/jocs.15906 ◽

2021 ◽

Author(s):

Rajesh K. Rao ◽

R. Varadaraju ◽

B. Girish ◽

Naveen Singh

Keyword(s):

Minimally Invasive ◽

Atrial Septal Defect ◽

Hepatic Vein ◽

Coronary Sinus ◽

Septal Defect ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Left Hepatic Vein ◽

Technical Challenges

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Superior Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Drainage—Minimally Invasive Approach—Case Report

Medicina ◽

10.3390/medicina57090984 ◽

2021 ◽

Vol 57 (9) ◽

pp. 984

Author(s):

Horațiu Moldovan ◽

Andra-Mădălina Sibișan ◽

Robert Țigănașu ◽

Bogdan-Ștefan Popescu ◽

Gabriel Vasile ◽

...

Keyword(s):

Minimally Invasive ◽

Atrial Septal Defect ◽

Septal Defect ◽

Venous Drainage ◽

Sinus Venosus ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Septal Defects ◽

Atrial Septal Defects ◽

Anomalous Pulmonary Venous Drainage

The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus atrial septal defects (SV-ASD), defined as a communication in the posterior part of the interatrial septum, account for about 5 to 10% of atrial septal defects. Approximately 90% of SV-ASDs are associated with partial anomalous pulmonary venous drainage (PAPVD). The minimally invasive approach has gained ground in the treatment of ASDs, especially those of the ostium secundum type. The sinus venosus type is a relatively uncommon form of ASD, which, when associated with a PAPVD, is considered a complex cardiac malformation, and is usually treated in a classical manner, through median sternotomy. We describe the case of a 45-year-old woman diagnosed in adolescence with SV-ASD with PAPVD, who successfully underwent minimally invasive repair with fresh autologous pericardial patch reconstruction through an anterolateral mini-thoracotomy incision. The patient presented with shortness of breath and fatigue after heavy exertions, episodes of paroxysmal nocturnal dyspnea, palpitations during effort and at rest, and had a history of syncope dating from 17 years previously. Echocardiography revealed an SV-ASD with PAPVD in the right atrium and the intraoperative examination discovered that both right pulmonary veins were draining into the superior vena cava.

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