PMC6197332_01
Aortic cannulation through the chest wall into the ascending aorta. A, a purse-string suture was made with a braided suture on the anterior wall of the ascending aorta, right beneath the semicircular fat plica (yellow arrow); B, a 12F-arterial cannula which was placed superiorly through right anterior chest wall in the 4th ICS, was directed into the ascending aorta inside the purse-string suture; C, introduce the arterial cannula into the ascending aorta until the brake on the cannula reached the aortic wall. ICS, intercostal space.
gr1.jpg
PMC6197332_01_gr1.jpg
fig0005
A 2-0, 17 mm braided suture (ETHIBOND EXCEL  Polyester Suture, ETHICON, JOHNSON & JOHNSON, Shanghai, China) was used to make a purse-string suture on the anterior wall of the ascending aorta, right beneath the semicircular fat plica (Fig. 1A) (Video 2). The arterial cannula was then introduced via this ostium into the ascending aorta until the brake on the cannula reached the aortic wall (Fig. 1B, C) (Video 3).
Cannulae and trocars set up on the chest wall. SVC cannula was inserted via the right jugular vein (black arrow), an arterial cannula was placed through the chest wall into the ascending aorta. One 12 mm trocar was used for main surgical field, three 5 mm trocars, CO2 pumping line was connected to the camera port. SVC, superior vena cava.
gr2.jpg
PMC6197332_01_gr2.jpg
fig0010
This process was performed from the outside combined with endoscopic visualization from inside to avoid injury to the internal thoracic artery and ensure that the cannula was best directed to the purse-string suture (Fig. 2). A CO2-pump line connecting to the camera port (Fig. 2) was used to fill the pericardial and pleural spaces with CO2.
Intra- and postoperative images. A, Inferior type SV-ASD: the superior edge of the defect was retracted, the ASD located in the inferior portion of the atrial septum that led to an overriding IVC. The defect was partially covered by the Eustachian valve (yellow star) and the RIPV (green arrow) partially returned to the RA near the IVC orifice; B, close ASD with an artificial patch; C, surgical scars prior to discharge, include (1): secondary working port, (2): camera port, (3): port for right heart sucker, (4): main working port (12 mm trocar), and (5): hole for aortic cannulation. SV-ASD, sinus venosus atrial septal defect; ASD, atrial septal defect; IVC, inferior vena cava; RIPV, right inferior pulmonary vein; RA, right atrium.
gr3.jpg
PMC6197332_01_gr3.jpg
fig0015
RIPV, an artificial patch was used to close the ASD and form a canal to drain blood from the RIPV to the LA through the ASD (Fig. 3A, B) (Video 5). Right before completing the ASD closure, the lung was inflated to remove air from the left atrium. Both the patient and his family were extremely satisfied with the cosmetic results of surgical scars (Fig. 3C).