Minimally invasive repair of fenestrated atrial septal aneurysm

Seph Naficy, James E. Klemis, Steven S. Gubin, William R. Funderburg, John M. Craig


Background: Atrial septal aneurysms (ASAs) are uncommon but are associated with significant embolic morbidity when an interatrial communication is present. Although surgical reconstruction has traditionally been approached through a median sternotomy, minimally invasive techniques may be employed to reduce pain and recovery time.
Methods: We present a video-assisted technique via right inframammary minithoracotomy utilizing peripheral cannulation for cardiopulmonary bypass. Included is a discussion of surgical tips, potential pitfalls and a description of unique technical aspects that differentiate atrial septal repair from other minimally invasive cardiac operations.
Results: A complete repair of the defect was confirmed by intraoperative transesophageal echocardiography (TEE). The patient made an uncomplicated recovery and was discharged home within 48 hours of surgery.
Conclusions: Minimally invasive repair of an ASA utilizing peripheral cannulation for cardiopulmonary bypass and a right inframammary incision can be accomplished with satisfactory technical success and recovery time.