I had always thought that this pathology required a full sternotomy, until now. This patient has a sinus venosus ASD with drainage of the right superior pulmonary veins into the SVC and a secundum ASD.  A minimally invasive option was proposed. I percutaneously placed a 16 FR arterial cannula into the right IJ after drapping the patient. Femoral  arterial and venous cannulation were also performed in the routine fashion. The incision in the chest is that of a double valve incision. It is a mini-thoracotomy incision  in the 2-3rd ICS and approximately 6cm in length (This is the same exact incision that I use for my mini aortic cases). Once on bypass, I encircled both the SVC and IVC with vessel loops. I also pull the femoral venous cannula into the IVC before snarring both cava’s. As you can see in the pictures, the incision starts over the SVC and extends onto the right atrium.  Once in the atrium, a baffle is created with pericardium, directing the right SPV blood flow into the left atrium via the ASD. Then to avoid stenosis of the SVC a pericardial patch is utilized to close the right atriotomy.  I have enclosed pictures.

I have another case exactly like this in 2 weeks.  I will let you know if I encounter anything different.