内視鏡下心臓手術における左心房側からの心房中隔欠損閉鎖術：症例報告

BACKGROUND Transcatheter atrial septal defect closure is currently the standard approach. In addition, minimally invasive cardiac surgery is preferable over median sternotomy. However, ensuring safe and reliable surgery is essential. The conventional right atrial approach is limited in its ability to ensure a clear surgical field and is associated with bleeding and postoperative arrhythmia. Herein, we describe atrial septal defect patch closure using a left atrial side approach in totally endoscopic minimally invasive cardiac surgery. CASE REPORT A 61-year-old man was admitted for heart failure caused by atrial fibrillation. Echocardiography revealed an atrial septal defect (27×17 mm; Qp/Qs ratio, 2.5). Given the relatively small aortic rim (1 mm), surgery after ablation of atrial fibrillation was selected. Complete pulmonary vein antrum isolation was performed using a catheter, followed by confirming sinus rhythm restoration. Two years later, the patient underwent atrial septal defect closure in a totally endoscopic minimally invasive cardiac surgery via the right axillary mini-thoracotomy under moderate hypothermia. The defect was accessed using a standard right-sided left atrial incision; brief circulatory arrest allowed secure suturing of the lower defect margin adjacent to the inferior vena cava, with minimal blood loss. The patient had an uneventful recovery. Postoperative echocardiography confirmed complete closure without residual shunting. CONCLUSIONS Compared with conventional right atriotomy, the left atrial side approach provided improved exposure, reduced bleeding, and easier air evacuation, potentially lowering the risk of long-term arrhythmias. This technique could offer a familiar and useful approach for enhancing the safety of atrial septal defect closures.