Minimally invasive anterior thoracotomy approach for complex sinus venosus atrial septal defect with anomalous...

Sinus venosus atrial septal defect (SVASD) is a rare congenital anomaly often associated with partial anomalous pulmonary venous return (PAPVR), leading to right heart volume overload and pulmonary hypertension. While traditionally managed via median sternotomy, minimally invasive approaches are emerging as effective alternatives, offering reduced surgical complication and improved outcomes.

We report a case of a 59-year-old female with a one-year history of recurrent episodes of spontaneous palpitations. Echocardiographic evaluation revealed a high SVASD with PAPVR, severe pulmonary hypertension, tricuspid regurgitation, and right heart enlargement. A minimally invasive repair was performed through a right anterior minithoracotomy, employing a double-patch technique to address the SVASD and PAPVR, along with tricuspid valve repair. The postoperative recovery was uneventful, with follow-up echocardiography confirming the absence of residual shunts, significant improvement in pulmonary artery pressure, and normalization of right ventricular function. At 1, 3, and 6 months follow-up, the patient showed excellent clinical outcome with no recurrence or complications.

This case highlights the feasibility and effectiveness of minimally invasive anterior thoracotomy for complex congenital heart defects. The double patch technique ensured optimal pulmonary venous redirection while preventing superior vena cava narrowing. The approach aligns with evolving trends in congenital heart surgery, emphasizing enhanced visualization, reduced surgical trauma, and superior cosmetic outcomes.

This case highlights the growing role of minimally invasive anterior thoracotomy as a safe and effective alternative for complex SVASD with PAPVR. As surgical techniques advance, this approach may become a preferred strategy for congenital cardiac repairs.