Repair of Atrial Septal Defect with Relief of Pulmonary Stenosis via Right Mini-Thoracotomy with Conventional Central Cannulation: A Case Report

Minimally invasive right mini-thoracotomy is conventionally performed with femoro-femoral cardiopulmonary bypass (CPB) cannulation. Central (aorto-caval) cannulation through the thoracotomy window, though technically demanding, avoids the morbidity associated with femoral access and does not require specialised minimally invasive equipments. Its applicability to combined congenital lesions — particularly atrial septal defect (ASD) with pulmonary stenosis (PS) — has not been widely described. Here we discuss the case of a 20-year-old female presenting with ostium secundum ASD and severe PS. She underwent combined intracardiac repair of ASD with a Dacron patch and relief of PS via pulmonary arteriotomy and right ventricular outflow tract (RVOT) resection through a right mini-thoracotomy approach with conventional central (aorto-caval) cannulation, without femoro-femoral bypass. Aortic cross-clamp time was 38 minutes, cardiopulmonary bypass duration 65 minutes, post-operative extubation at 6 hours, and total drain output 100 mL. There were no procedure-related complications. Post-operative echocardiography confirmed no residual ASD shunt and satisfactory relief of right ventricular outflow obstruction. This report emphasizes that combined ASD repair and PS relief via right mini-thoracotomy with central cannulation is safe, reproducible and technically feasible without dedicated minimally invasive equipment. This approach minimises sternotomy-related morbidity, reduces cost and yields excellent cosmetic results — particularly advantageous in young female patients.