A 24-year-old male presented with chest pain and dizziness. His medical history was notable for emphysematous lung changes, most likely related to heavy smoking.
Holter monitoring performed after admission demonstrated a high burden of premature ventricular contractions (PVCs). Subsequent evaluation by echocardiography revealed an 8 mm ventricular septal defect (VSD) with a left-to-right shunt, as well as a double-chambered right ventricle. An intraventricular peak pressure gradient of 145 mmHg was measured, consistent with severe right ventricular outflow tract obstruction. Biventricular function was preserved.
The femoral vessels and the right internal jugular vein were cannulated. A minithoracotomy was then performed in the right anterior axillary line and a camera port was inserted.
The aorta was cross-clamped and antegrade Bretschneider cardioplegia was administered. An aortotomy was then performed. Stay sutures were placed, and the anatomy was inspected.
The defect was located directly beneath the right coronary cusp, immediately adjacent to the aortic annulus.
A Gore-Tex patch was trimmed to size and used to close the VSD with running sutures. Along the superior margin, three singular U-stitches were placed through the aortic annulus to avoid distortion of the cusp.
The aorta was closed after a competent sealing test, and the right atrium opened. The right ventricular muscular bundles were then inspected through the tricuspid valve. Careful resection of the bundles was performed; however, this portion of the procedure was not captured on video.
The right atrium was then closed and the patient was successfully weaned from cardiopulmonary bypass.
Postoperative echocardiography demonstrated a complete closure of the VSD, no residual turbulence within the right ventricle, and normalization of the right ventricular (RV) pressure gradients.
The patient was extubated in the operating room and transferred to the intensive care unit without catecholamine support. After an uneventful course, the patient was discharged home on postoperative day five.
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