Abdul-Hafez Hamza A, Jabbarin Farah M, Alkhatib Hasan, Tamimi Helmi Mahmoud, Abutaqa Mohammed
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Department of Cardiology, Al Makassed Hospital, Jerusalem, Palestine.
Int J Surg Case Rep. 2025 Apr;129:111199. doi: 10.1016/j.ijscr.2025.111199. Epub 2025 Mar 25.
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.
静脉窦型房间隔缺损（SVASD）是一种罕见的先天性异常，常与部分性肺静脉异位引流（PAPVR）相关，导致右心容量负荷过重和肺动脉高压。传统上通过正中胸骨切开术进行治疗，而微创方法正在成为有效的替代方案，可减少手术并发症并改善预后。
我们报告一例59岁女性，有一年反复发作的自发性心悸病史。超声心动图评估显示存在高位SVASD伴PAPVR、严重肺动脉高压、三尖瓣反流和右心扩大。通过右前小切口开胸进行微创修复，采用双补片技术处理SVASD和PAPVR，并进行三尖瓣修复。术后恢复顺利，随访超声心动图证实无残余分流、肺动脉压显著改善以及右心室功能恢复正常。在1个月、3个月和6个月随访时，患者临床结果良好，无复发或并发症。
该病例突出了微创前胸切开术治疗复杂先天性心脏缺陷的可行性和有效性。双补片技术确保了最佳的肺静脉重定向，同时防止上腔静脉狭窄。该方法符合先天性心脏手术的发展趋势，强调增强可视化、减少手术创伤和更好的美容效果。
该病例突出了微创前胸切开术作为治疗伴有PAPVR的复杂SVASD的安全有效替代方法的作用日益增加。随着手术技术的进步，这种方法可能成为先天性心脏修复的首选策略。
