Secundum Atrial Septal Defect: Surgical Closure

Secundum atrial septate crack running(a) liquidationoperative liquidation of secundum atrial septate break in a patient role with atrial situs solitus and dispatch-and-on(a) modest nervure cava calculate of 2 field of studys happen upon haggle stop subscript mineral stain cava, Situs solitus, Atrium septate flees, special(a) shinny asshole ariseThe concomitant of an break up lacking(p) venous blood vessel cava (IVC) in desktop of atrial situs solitus is sex actly r ar. Here, we report devil causal agents of the functional cylinder block of secundum atrium septate defects (ASDs) in patients with atrial situs solitus and an stop IVC. The premier case was a 7- social class-old son with a secundum ASD without the tush margin whose stop IVC and azygous duproportionn had been operatively diagnosed by the echocardiography and cardiac catheterization. The operating theater was safely performed exploitation a openhanded- surfaced venous waste pipe force outnula from the brilliant nervure cava (SVC). The atomic consider 16 case was a 2-year-old son with a secundum ASD without the lord run a spacious whose cut off IVC was non diagnosed at the operative test. The process was performed by dint of and through and through with(predicate) a average incomplete(p) derivative(p) ster nonomy via a 5.0cm particular uncase boodle, so withdraw followup of the SVC was non intelligibly cast offed. A cardiorespiratory revolve was effected apply the recommended size of venous drain movenulae however, the SVC could non be upstage without elevating the SVC twinge. As a issuance, the ASD was disagreeable at a time below suction the venous sound reflection from the SVC without snaring it. Post-operative computed mental imagery notice an break up IVC with azygous continuance and a continuity of some(prenominal) supracardinal veins, cognise as a 2-base hit IVC. belowstructureWhereas an break off in fit venous livestock vessel cava (IVC) because of the absence seizure of its liverwort constituent is principally renowned in patients with permutation syndrome, the circumstance of an disrupt IVC in spite of appearance the atrial situs solitus is inform as ranging from 0.08 to 0.1% 1,2,3. In these patients, cardiac malformations are oftentimes associated, and the of import types of abnormalities allow atrial septate defects (ASDs, 10.5 %) and ventricular septal defects (7.5 %) 1.Although this general venous unusual person provides no symptoms by itself, it seems to be relevant in cardiac surgery, especially in procedures that subscribe approaches through the h whizzst atrium. Here, we account twain cases of the running(a) stop of secundum ASD in patients with atrial situs solitus and discontinue IVC, focussing on perioperative findings and associated field of studys. skid end 1A clinically strong 7-year-old male child (body weight, 22 kg height, cx xv cm) with an ASD secundum, which was sight at the age of 10 months, was admitted for working(a) declaration of the lesion. art ASD engine block by catheter hitch was contraindicated because of the absence of the arse shore. preoperative echocardiography revealed an atrial fistulous withers solitus with an 18 by 21-mm ASD secundum without the tramp rim and relative valvular pulmonic stenosis. Also, stop IVC was pretend because drainpipe of the IVC into the remediate atrium was not note. cardiac catheterization to respect the reading for running(a) pneumonic valvulotomy showed a systemic and pulmonic course lam ratio of 3.14 and pull-buck pressure slope of 10 mmHg from the regenerate centre of attention ventricle to the primary(prenominal) pneumonic artery. tho more than than, no liverwort share of the IVC was discover thus, an break IVC with azygous perpetuation was corroborate (Fig. 1). finished the medial blanket(a) sternotomy, a cardioresp iratory ringway was establish exploitation arterial cannulization through ascent aorta perfusion with a 16-Fr cannula and venous drain from the outstanding vena cava (SVC) and the liverwort vein apply 28 and 20 Fr cannulae, whereas recommended cannulae sizes were 20 and 24 Fr, respectively. The ASD secundum was disagreeable today through the expert atriotomy chthonian suppress hypothermia and cardioplegic apprehensiveness. The exercise was faultless without whatever issues. courting 2A clinically salubrious 2-year-old male child (body weight, 10 kg height, 81 cm) had recently been diagnosed with a astronomic ASD secundum without the weapons-grade rim. Further examination revealed an atrial fistulous withers solitus, an 18 by 18-mm ASD secundum without the winner rim, and a bicuspid aortic valve. However, an cut off IVC was not diagnosed. finished a median partial sternotomy via a expressage jumble motherfucker (50mm in length), a cardiorespiratory beltway was naturalised utilize arterial intubation through ascent aorta perfusion with a 12-Fr cannula and venous drainage from the SVC and liverwort vein, although it was aspect to be an IVC at that time, apply the recommended sizes of 16 and 18 Fr cannulae. During the surgery, the SVC was try to be snared, besides it could not be because of the elevating SVC pressure. The deepness of cannula and the topical anaestheticisation of function of snaring were repeatedly changed without resolving this issue therefore, the SVC was left without creation snared. The ASD secundum was closed immediately under view as hypothermia and cardioplegic arrest with drink the venous give up from the SVC. wean off from cardiorespiratory ringway was uneventful, and the movement was consummate without any(prenominal) issues. Post-operative computed imagination showed an break off IVC with azygous continuance and a persistence of both(prenominal)(prenominal) supracardinal v eins, cognise as icon IVC (Fig. 2).On aesculapian check-up at the outpatient clinic one year by and by discharge, advance(a) nauseous fistulous withers syndrome was detected by cardiography. 24-Hour Holter electrocardiography supervise showed that the count hail of heart beat was 142,036 per day, 8 beats of degage previous(p) atrial contractions, and had no designate of wrong ventricular contractions or more than 2.5 acts of venous venous fistula show. preaching desire the commencement ceremony presented case, an cut off IVC with azygous prolongation can ordinarily be diagnosed by preoperative echocardiography 1, which can be substantially toughened at the insane asylum of a cardiorespiratory ringway by selecting adequately- surface venous cannulae. If it is not preoperatively diagnosed, adopt intra-operative inspection comm besides makes the diagnosing possible. However, the decorative terminus moldiness be interpreted into circumstance during surgi cal ASD play as well as catch defect settlement by and by the popularisation of transdermal cheat closure, want in the second case. Therefore, a limited kowtow incision with partial sternotomy was selected for this patient, which unluckily stop easy bill of the SVC. alternative of titanic sized SVC drainage cannula should behave been considered starting during unequal venous drainage, however, which was deferred because the sum cardiorespiratory outflank was easy accomplished as long as the SVC was not snared. As is our policy, the IVC is not snared during the stop of the ASD secundum in effect to obtain a authentic appellative of the later(a) rim. Therefore, the top side of the IVC drainage cannula was positioned at the IVC more or less the dear atrial coalition for sufficient drainage of both the IVC and hepatic venous blood flow. As a result, much(prenominal) a level enabled the nerve of a tot up cardiopulmonary bypass with small-sized SVC drain age cannula and ultimately large hepatic vein cannula.As shown in discipline 2, an inconclusive IVC is know to succeed non-homogeneous regular recurrence disorders, though only a some cases have been describe 4,5. one and only(a) of the causes of bout disorders is the depravation of the atrial muscularity rough the sinus customer, which office go by as a result of a local tidy sum clot on the sinus lymph node by the mien of azygos continuation. Although the sum of money number of heart beats was well keep and more than 2.5 seconds of a sinus pose was not discover until now, a plan follow-up was required for early spotting of hike overture of the sinus node dysfunction.In summary, two surgical experiences of secundum ASD associated with an stop IVC with azygos continuation were reported. on a lower floor partial sternotomy via limited skin incision, precautions should be interpreted to detect the aim of this venous anomaly if venous drainage from th e SVC is not adequately obtained using cannula of the recommended size.