Surgical Correction of a Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connections Using Cardiac Computed Tomography Imaging and a 3D-Printed Model

Abstract

Simple Summary This report describes the case of a sinus venosus atrial septal defect, concurrent with partial anomalous pulmonary venous connections, which is a rare congenital heart disease in dogs. In patients with hemodynamically significant changes and clinical signs, treatment of the defect is essential. There are various treatment options for an atrial septal defect, including surgical correction under cardiopulmonary bypass or inflow occlusion, and interventional closure with occluders. In this case, given the significant size of the defect and the presence of concomitant vascular anomalies, performing closure with a pericardial patch under a cardiopulmonary bypass is considered as the most suitable approach. Additionally, employing a cardiac model from computed tomography imaging facilitated a preoperative simulation, enhancing the precision and efficiency of the surgical procedure, both in terms of accuracy and time. To the best of our knowledge, this is the first reported case in dogs with a sinus venosus atrial septal defect, accompanied by partial anomalous pulmonary venosus connections, where a computed tomography-based three-dimensional cardiac model was created to precisely identify the defect's location and associated cardiovascular anomalies, leading to a successful surgical intervention under a cardiopulmonary bypass.Abstract Sinus venosus atrial septal defects (SVASDs), concurrent with partial anomalous pulmonary venous connections (PAPVCs), are a rare congenital heart disease in dogs. Surgical correction is essential when clinical signs or significant hemodynamic changes are present. We aimed to report on the successful surgical correction of an SVASD with PAPVCs, using a computed tomography (CT)-based customized 3D cardiac model. A 10-month-old male poodle was referred for corrective surgery for an ASD. Echocardiography confirmed a hemodynamically significant left-to-right shunting flow through an interatrial septal defect and severe right-sided heart volume overload. For a comprehensive diagnosis, a CT scan was performed, which confirmed an SVASD with PAPVCs. A customized 3D cardiac model was used for preoperative decision-making and surgical rehearsal. The defect was repaired using an autologous pericardial patch under a cardiopulmonary bypass (CPB). Temporary pacing was applied for sinus bradycardia and third-degree atrioventricular block. The patient recovered from the anesthesia without further complications. The pacemaker was removed during hospitalization and the patient was discharged without complications 2 weeks post-surgery. At the three-month follow-up, there was no shunting flow in the interatrial septum and the right-sided volume overload had been resolved. The cardiac medications were discontinued, and there were no complications. This report indicates the validity of surgical correction under CPB for an SVASD with PAPVCs, and the advantages of utilizing a CT-based 3D cardiac model for preoperative planning to increase the surgical success rate.