Intra-Atrial Rerouting and Maze Procedure for an Adult Patient in Cor Triatriatum, Persistent Left Superior Vena Cava, and Atrial Fibrillation Koichi.

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Presentation transcript:

Intra-Atrial Rerouting and Maze Procedure for an Adult Patient in Cor Triatriatum, Persistent Left Superior Vena Cava, and Atrial Fibrillation Koichi Sughimoto, MD, Kozo Matsuo, MD, Masanao Ohba, MD The Annals of Thoracic Surgery Volume 93, Issue 6, Pages 2056-2058 (June 2012) DOI: 10.1016/j.athoracsur.2011.10.043 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative transthoracic echocardiograam from the apex of the heart. (ASD = atrial septal defect; Dp = diaphragm; LV = left ventricle; M = mitral valve; RV = right ventricle; P = primary chamber; S = secondary chamber; T = tricuspid valve.) The Annals of Thoracic Surgery 2012 93, 2056-2058DOI: (10.1016/j.athoracsur.2011.10.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The right atrium was incised obliquely. A yellow Swan-Ganz catheter was passed from the right superior vena cava to the right ventricle. A hook is hung to the edge of the secundum atrial septal defect (ASD). A forceps was passed from the left atrial appendage, with the end of the forceps appearing in the secondary chamber in the left atrium. A suction tube was inserted into the restricted communication between the secondary and the primary chamber. The Annals of Thoracic Surgery 2012 93, 2056-2058DOI: (10.1016/j.athoracsur.2011.10.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The primary atrial chamber was entered through the right pulmonary vein. (A) The right atrium was incised and a Nelaton tube from the left atrial appendage was passed anterior to the diaphragm through the secundum atrial septal defect (ASD). (B) Surgical overview. (C) A GoreTex tube was sutured to the internal orifice of the LSVC from the incision into the left atrial appendage, after which the other side of the tube was sutured along the superior side of the rim of the ASD. (D)The remainder of the defect was closed with another GoreTex patch. (CS = coronary sinus; DP = diaphragm; GP = GoreTex patch; GT = GoreTex tube; LAA = left atrial appendage; LSVC = left superior vena cava; MV = mitral valve; NT = Nelaton tube; PV = pulmonary veins; TV = tricuspid valve.) The Annals of Thoracic Surgery 2012 93, 2056-2058DOI: (10.1016/j.athoracsur.2011.10.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Arrow shows reconstructed intra-atrial rerouting flow from the left superior vena cava to the right atrium in a coronal view made with three-dimensional computed tomography. The Annals of Thoracic Surgery 2012 93, 2056-2058DOI: (10.1016/j.athoracsur.2011.10.043) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions