Sinus Venosus ASD With Large Shunt and Cardiac Collapse
Pericardial Patch Repair of Sinus Venosus ASD
"Two-Patch" Technique for Atriotomy Repair
After a series of diagrams for the Division of Cardiothoracic Surgery, University of Washington.

This middle-aged otherwise well patient presented with precipitous severe cardiac failure. Transthoracic echocardiography demonstrated severe 4-chamber dilatation with estimated left ventricular ejection fraction 25-30% and pulmonary systolic 43-48 mmHg. Bidirectional transseptal flow was noted across the high interatrial septum. Cardiac catheterization demonstrated a large sinus venosus ASD with Qp/Qs 2.9 and atrial SvO2 increment from 71% to 79%. Intraoperative transesophageal echo showed a 3-cm sinus venosus ASD with overriding right pulmonary veins (Figure 1 and 2).

The defect was closed with a pericardial baffle isolating and assigning the pulmonary vein ostia to the LA.

Because of the size of the defect and geometry of overriding pulmonary veins, the resulting SVC-RA junction was considerably narrower. The SVC thus was expanded laterally with another pericardial patch incorporated into the atriotomy closure, the two-patch technique(Figure 3).