DENTON A. COOLEY, M.D., PAUL R. ELLIS, M.D., MIGUEL E. BELLIZZI, M.D.

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Presentation transcript:

Atrial Septal Defects of the Sinus Venosus Type: Surgical Considerations DENTON A. COOLEY, M.D., PAUL R. ELLIS, M.D., MIGUEL E. BELLIZZI, M.D. Diseases of the Chest Volume 39, Issue 2, Pages 185-192 (February 1961) DOI: 10.1378/chest.39.2.185 Copyright © 1961 The American College of Chest Physicians Terms and Conditions

FIGURE 1 (left) Drawing showing the anatomic characteristics of a typical sinus venosus type of atrial septal defect. The defect is located high in the septum and the superior septal margin is absent. Veins from the right upper and occasionally middle lobes drain anomalously into the right atrium. Diseases of the Chest 1961 39, 185-192DOI: (10.1378/chest.39.2.185) Copyright © 1961 The American College of Chest Physicians Terms and Conditions

FIGURE 2 (right) Drawing showing a variation of usual sinus venosus defect in which the pulmonary veins of the right upper lobe are implanted directly into the superior vena cava. This type of venous drainage requires special consideration from the standpoint of surgical repair. Diseases of the Chest 1961 39, 185-192DOI: (10.1378/chest.39.2.185) Copyright © 1961 The American College of Chest Physicians Terms and Conditions

FIGURE 3 Diagrams showing normal (A,B,C) and abnormal (B',C) development of interatrial septum. Normally the sinus venosus (A) shifts toward the right as the left superior cardinal vein atrophies. The septum primum and right superior vena cava are separated by an interseptovalvular space (B). In this space the septum secundum develops and descends closing the ostium secundum which may remain only as a foramen ovale (C). In B' the sinus venosus failed to migrate far enough toward the right so that the interseptovalvular space is absent. The septum secundum does not form superiorly and the ostium secundum remains open without a superior margin, forming a typical sinus venosus atrial septal defect (C').7 Diseases of the Chest 1961 39, 185-192DOI: (10.1378/chest.39.2.185) Copyright © 1961 The American College of Chest Physicians Terms and Conditions

FIGURE 4 Drawings showing technic of repair of a sinus venosus type of atrial septal defect. In (a.) the knitted Dacron patch is being sutured over the interatrial communication in a position which directs the flow from the anomalous pulmonary veins into the left atrium. In (b.) the defect is repaired without tension and without constriction or distortion of pulmonary veins or superior vena cava. Diseases of the Chest 1961 39, 185-192DOI: (10.1378/chest.39.2.185) Copyright © 1961 The American College of Chest Physicians Terms and Conditions