Robotic-Assisted Repair of Supracardiac Total Anomalous Pulmonary Venous Return

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Background 

Supracardiac total anomalous pulmonary venous return (TAPVC) is a rare congenital cardiac anomaly characterized by the anomalous drainage of all pulmonary veins into the systemic venous circulation rather than the left atrium. It is typically diagnosed in infancy and late presentations in adults are exceptionally uncommon. Robotic-assisted minimally invasive techniques have enabled the safe management of complex congenital defects, offering enhanced visualization and precision.​ 

Case Presentation 

A 26-year-old female presented during her first pregnancy with dyspnea and palpitations. Transthoracic echocardiography identified supracardiac TAPVC with confluence posterior to the left atrium, a large secundum atrial septal defect (ASD) with a right-to-left shunt, and pulmonary hypertension (mean pulmonary arterial pressure [PAP] of 55 mmHg). Catheter angiography confirmed drainage of the right upper, right lower, and left lower pulmonary veins into a single confluence, forming a vertical ascending vein that drained into the innominate vein. The left lower pulmonary vein drained directly into the vertical vein. 

Surgical Technique

The patient underwent robotic-assisted rerouting of TAPVC with patch closure of the ostium seccundum ASD via peripheral cardiopulmonary bypass using the DaVinci Xi robotic platform. Six strategically placed intercostal ports equipped with four robotic arms were positioned in the second, third, fifth, and seventh intercostal spaces using right-chest access. 
 
Outcomes 

The patient's postoperative course was uneventful, with no anastomotic obstruction or residual shunt. She was discharged in stable condition with optimal functional recovery. This case demonstrates the safety, feasibility, and technical advantages of robotic-assisted minimally invasive repair for supracardiac TAPVC with complex anatomy in appropriately selected adult patients. 

Conclusion 

The robotic-assisted endoscopic approach to supracardiac TAPVC repair represents a novel minimally invasive technique that provides favorable outcomes in select cases. The authors present the first reported robotic-assisted repair of supracardiac TAPVC with concurrent ASD closure in an adult patient, establishing this method as a feasible and preferred approach for experienced minimally invasive cardiac surgery centers.​ 

References

1. Mery CM, Gangemi JJ, Kron IL. Anomalies of pulmonary venous return. Thoracic Key; 2017 [cited 2025 Dec 5]. Available from: https://thoracickey.com/anomalies-of-pulmonary-venous-return
2. Frontiers in Cardiovascular Medicine. Successful surgical repair in an older adult with supracardiac total anomalous pulmonary venous connection: A case report. Front Cardiovasc Med. 2023;10:1121037.

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