Robotic-assisted two-patch repair of right partial anomalous pulmonary venous connection and sinus venosus defect

摘要

Central MessagePAPVCs remain uncommon, particularly in the adult. We present a repair of right partial pulmonary venous connection and sinus venosus defect with a 2-patch technique performed robotically.See Commentaries on pages 265, 267, and 269. PAPVCs remain uncommon, particularly in the adult. We present a repair of right partial pulmonary venous connection and sinus venosus defect with a 2-patch technique performed robotically. See Commentaries on pages 265, 267, and 269. Partial anomalous pulmonary venous connection (PAPVC) consists of an abnormal drainage of 1 or more pulmonary veins into the systemic venous system. The incidence of PAPVC has been reported to be between 0.6% and 0.7%, and it is commonly associated with a sinus venosus atrial septal defect (ASD).1Said S.M. Burkhart H.M. Schaff H.V. Cetta Jr., F. Phillips S.D. Barnes R.D. et al.Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: does it matter?.J Thorac Cardiovasc Surg. 2012; 143: 896-903Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar,2Gustafson R.A. Warden H.E. Murray G.F. Hill R.C. Rozar G.E. Partial anomalous pulmonary venous connection to the right side of the heart.J Thorac Cardiovasc Surg. 1989; 98: 861-868Abstract Full Text PDF PubMed Google Scholar Initial presentation in adulthood remains uncommon. Surgical repair can be successfully achieved via caval division and reconnection (Warden procedure),2Gustafson R.A. Warden H.E. Murray G.F. Hill R.C. Rozar G.E. Partial anomalous pulmonary venous connection to the right side of the heart.J Thorac Cardiovasc Surg. 1989; 98: 861-868Abstract Full Text PDF PubMed Google Scholar,3Shahriari A. Rodefeld M.D. Turrentine M.W. Brown J.W. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection.Ann Thorac Surg. 2006; 81: 224-229Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar or a 2-patch technique to close the ASD while baffling the anomalous pulmonary venous return to the left atrium and expanding the cavoatrial confluence.1Said S.M. Burkhart H.M. Schaff H.V. Cetta Jr., F. Phillips S.D. Barnes R.D. et al.Single-patch, 2-patch, and caval division techniques for repair of partial anomalous pulmonary venous connections: does it matter?.J Thorac Cardiovasc Surg. 2012; 143: 896-903Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 2Gustafson R.A. Warden H.E. Murray G.F. Hill R.C. Rozar G.E. Partial anomalous pulmonary venous connection to the right side of the heart.J Thorac Cardiovasc Surg. 1989; 98: 861-868Abstract Full Text PDF PubMed Google Scholar, 3Shahriari A. Rodefeld M.D. Turrentine M.W. Brown J.W. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection.Ann Thorac Surg. 2006; 81: 224-229Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar The current case is a 2-patch repair performed robotically. A 114-kg, 30-year-old active male laborer with a body mass index of 33 kg/m2 with no previous history of congenital or adult illness presented with increasing dyspnea on exertion with New York Heart Association class 3 symptoms. Transthoracic echocardiography identified a large ASD with significant enlargement of both the right atrium and right ventricle. This was further identified by transesophageal echocardiography (TEE) and computed tomography angiography to be a right PAPVC draining both the right upper lobe and middle lobe into the posterior superior vena cava (SVC) 1.5 cm proximal to the cavoatrial junction via a sinus venosus defect. The patient was referred for correction, and he desired non-sternotomy possibilities. Fully informed consent was obtained for both sternotomy and minimally invasive options. The patient was prepared with double-lumen endotracheal intubation, right internal jugular central line, and left upper-extremity arterial line. Cannulation was