MP01. 3D Totally Endoscopic Atrial Septal Defect & Tricuspid Regurgitation Repair in a Patient with Situs Inversus
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Cardiovascular Surgeon at Asan Medical Center, currently doing a fellowship.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective
Atrial septal defect (ASD) is one of the most common congenital heart diseases in adult patients, frequently accompanied with tricuspid regurgitation. In this situation, minimally invasive approaches have been used to reduce surgical trauma and improve cosmesis. However, special consideration is needed in the case of situs inversus with dextrocardia. Herein, we present a situs inversus patient who underwent ASD closure, tricuspid repair with totally endoscopic approach.
Case video summary
A 47-year-old female alleged ASD patient presented with dyspnea. A transthoracic echocardiogram showed dextrocardia with a secundum ASD of 25 mm in diameter, moderate degree of the tricuspid valve regurgitation due to annular dilatation. Cardiopulmonary bypass was established via femoral cannulation. A 3-cm mini-thoracotomy incision (working port) was made, and an endoscopic 10mm trocar was inserted. Under induced fibrillatory heart, right atriotomy was performed. The ASD was closed using Gore-Tex patch with 4-0 polypropylene running suture. The tricuspid valve showed an annular dilatation and anterior leaflet prolapse. Because the patient's heart is a mirror image, the usual 3D ring did not fit the tricuspid valve, so flat ring was used. Intraoperative transesophageal echocardiography showed no remnant shunt or tricuspid valve regurgitation. The postoperative course was uncomplicated, and the patient was discharged on postoperative days 5.
Conclusions
Minimally invasive totally endoscopic ASD closure, tricuspid repair were performed safely in a patient with situs inversus.
Atrial septal defect (ASD) is one of the most common congenital heart diseases in adult patients, frequently accompanied with tricuspid regurgitation. In this situation, minimally invasive approaches have been used to reduce surgical trauma and improve cosmesis. However, special consideration is needed in the case of situs inversus with dextrocardia. Herein, we present a situs inversus patient who underwent ASD closure, tricuspid repair with totally endoscopic approach.
Case video summary
A 47-year-old female alleged ASD patient presented with dyspnea. A transthoracic echocardiogram showed dextrocardia with a secundum ASD of 25 mm in diameter, moderate degree of the tricuspid valve regurgitation due to annular dilatation. Cardiopulmonary bypass was established via femoral cannulation. A 3-cm mini-thoracotomy incision (working port) was made, and an endoscopic 10mm trocar was inserted. Under induced fibrillatory heart, right atriotomy was performed. The ASD was closed using Gore-Tex patch with 4-0 polypropylene running suture. The tricuspid valve showed an annular dilatation and anterior leaflet prolapse. Because the patient's heart is a mirror image, the usual 3D ring did not fit the tricuspid valve, so flat ring was used. Intraoperative transesophageal echocardiography showed no remnant shunt or tricuspid valve regurgitation. The postoperative course was uncomplicated, and the patient was discharged on postoperative days 5.
Conclusions
Minimally invasive totally endoscopic ASD closure, tricuspid repair were performed safely in a patient with situs inversus.