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Atrial Septal Defect Patch Closure From the Left Atrial Side Approach in Totally Endoscopic Minimally Invasive

Shizuya Shintomi1, Takashi Oshitomi1, Kenetaro Takaji1

  • 1Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

The American Journal of Case Reports
|December 30, 2025
PubMed
Summary

This study introduces a novel left atrial approach for atrial septal defect closure during minimally invasive cardiac surgery. This technique enhances surgical visualization and reduces bleeding, potentially lowering arrhythmia risks.

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Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Procedures
  • Congenital Heart Defect Repair

Background:

  • Transcatheter atrial septal defect (ASD) closure is standard, but minimally invasive surgery is preferred over sternotomy.
  • Conventional right atrial approaches for ASD closure present challenges in surgical field visualization, bleeding, and postoperative arrhythmia.
  • A novel left atrial side approach in totally endoscopic minimally invasive cardiac surgery is presented for ASD patch closure.

Purpose of the Study:

  • To describe a novel left atrial side approach for atrial septal defect patch closure.
  • To evaluate the safety and efficacy of this technique in totally endoscopic minimally invasive cardiac surgery.
  • To compare the benefits of the left atrial approach versus the conventional right atrial approach.

Main Methods:

  • A 61-year-old male patient with heart failure due to ASD and atrial fibrillation underwent catheter ablation for rhythm control.
  • Two years post-ablation, the patient underwent totally endoscopic minimally invasive ASD closure via right axillary mini-thoracotomy under moderate hypothermia.
  • A left atrial incision was used for defect access, with brief circulatory arrest enabling secure suturing and minimizing blood loss.

Main Results:

  • The left atrial side approach provided improved surgical exposure and facilitated easier air evacuation.
  • The procedure resulted in minimal blood loss and an uneventful patient recovery.
  • Postoperative echocardiography confirmed complete atrial septal defect closure without residual shunting.

Conclusions:

  • The left atrial side approach offers superior exposure and reduced bleeding compared to conventional right atriotomy for ASD closure.
  • This technique may lower the risk of long-term arrhythmias by improving surgical conditions and air management.
  • The described method presents a familiar and potentially safer alternative for enhancing atrial septal defect closure procedures.