Abstract
Here we report two cases of residual atrial septal defect (ASD) with
inferior extension towards the inferior vena cava (inferior sinus
venosus type). In both cases, patients underwent surgical repair of
their ASD in childhood. However, signs of persistent hemodynamic right
ventricular overload were detected at the last follow-up and a residual
ASD was demonstrated. Both underwent successful minimally invasive
surgical closure of the ASD by combining a right postero-lateral
mini-thoracotomy (sub-axillary approach) and total peripheral
cardiopulmonary bypass, avoiding snaring of the inferior vena cava. This
allowed an optimal visualization of the residual intra-cardiac shunt and
its subsequent closure.