Sinus venosus atrial septal defect in adults: Where we are and where we go? Initial experience of percutaneous repair

Introduction Percutaneous repair of sinus venosus atrial septal defect (SV ASD) has emerged with promising preliminary results. We sought to expose the modified management strategy for this pathology in our tertiary center. Methods Since March 2020, date of the first percutaneous procedure, therapeutic strategy for SV ASD patients has changed and was based on cardiac CT and 3D STL models for anatomic analysis in all patients. Flow-MRI and 3D printing were produced in selected cases to upgrade anatomic understanding and strategy decision ( Fig. 1 ). Forecast success and issues were studied based on anatomic findings. Safety, efficiency and follow-up with both technics were noticed for decision making. Results From March 2020 to March 2021, 18 adults patients were reffered for SV ASD closure. Median age was 47 years old (18 to 84 years old) ( Fig. 2 ). Surgical correction was performed in 5 patients (27.8%) using patch baffle (3/5) or Warden technique (2/5). Length of hospital stay was 8 ± 3 days and no major event occurred. Immediate surgical results were excellent in all cases. Percutaneous closure was performed in 4 cases (22.2%). Procedures were simulated on 3D printed models in all cases. Procedures were guided using transesophageal echocardiography, fusion between fluoroscopy and echography, and fusion between CT scan and fluoroscopy. One residual shunt occurred but disappeared on the cath control at month 3. Stents used were covered CP10Z80, CP10Z70, CP 10Z60, and Bentley begraft aortic in one case. In two cases, covered stents were stabilized by adding bare metal stents. All 4 patients were discharged at day 3 with acetylsalicylic acid therapy. Eight of nine pending patients for percutaneous closure will be planned in 2021. Conclusion Percutaneous management of SVASD was safe and efficient in selected cases. Pre-procedural multimodality imaging including 3D modeling appears to be a necessary condition for a tailored patient's selection.