I have tried to repair a sinus venosus ASD with PAPVR in the past via a minimally invasive mitral valve approach.  This was extremely difficult and the exposure was very poor and required conversion to a sternotomy.  I recently operated upon another patient with this pathology and realized that I needed to be closer to the SVC.  I decided to approach the case via a double valve (AVR/MVR) approach/incision.  The exposure was excellent and the operation was not compromised at all.  The arterial cannulation was via the right femoral artery and the venous with a long 25 Fr. Biomedicus cannula placed in the femoral vein.  This was subsequently positioned in the IVC after establishing CPB.  I also inserted an 18 Fr. arterial cannula in the right IJ via percutaneous access. A two patch technique was utilized to repair the defect. One pericardial patch was placed over the right superior pulmonary veins and ASD in order to redirect flow back into the left atrium and another patch over the SVC to avoid stenosis. The patient did very well and despite a long history of COPD she was discharged home on POD # 5.  I have now confirmed that all atrial septal defects can be repaired with a mini thoracotomy approach. In addition, I also propose that this technique be the standard of care for this pathology.

                                                                                                                                                                      Minimally invasive incision to repair PAPVR and sinus venosus ASD

SVC snarred, suction through ASD, blood return from RSPV’s

pericardial patch over RSPV’s and sinus venosus ASD

                pericardial patch over SVC and right atrium