Surgical closure of sinus venosus atrial septal defect using a single patch--transcaval repair technique

We would like to share our experience of surgical repair of sinus venosus atrial septal defect (ASD) using a simple "transcaval repair technique."

Between January 2007 and October 2010, 48 consecutive patients of sinus venosus ASD underwent surgical repair using transcaval repair technique at our institute. Their ages ranged from 5 to 15 years and male to female ratio was 1.6:1. The principles of the technique were longitudinal incision over the lateral aspect of superior vena cava (SVC) at the entry point of anomalous right pulmonary veins, use of a single autologous untreated pericardial patch, and finally closure of the caval incision in such a way that the patch gets sandwiched between two caval lips.

All 48 patients came off cardiopulmonary bypass in sinus rhythm. The average pressure gradient across the patch was 3 mmHg. Immediate postoperative electrocardiograms and echocardiograms showed all patients were in sinus rhythm with no residual shunt and no pulmonary or systemic venous obstruction respectively, except in one patient who required SVC augmentation. The follow-up was done at three months (100%), one year, and two years. All patients were asymptomatic and their electrocardiograms and transthoracic echocardiograms revealed sinus rhythm, no residual shunt, and no obstruction to systemic or pulmonary venous drainage, respectively. There was no early or late mortality.

We conclude that this technique is safe and simple for the repair of selected cases of sinus venosus atrial septal defect with partial anomalous pulmonary venous connection and it preserves the sinoatrial node function after surgery.