Figure 1: a) External rib retractor with flexible aortic cross clamp; b) Incision site
A floppy vent cardiotomy sucker was dropped into the open left pulmonary veins, and a retractor was used to elevate the right atrial wall and expose the ASD. Direct visualization was found to be excellent with this procedure. Atrial septal defect closure was performed using a glutaraldehyde-treated pericardial patch via conventional instruments, as well as the continuous suture technique. The right atrial closure was then completed. The cross-clamp was released after proper de-airing, and when the patient had been weaned from the CPB, decannulation was conducted as well. Finally, the chest closed in layers keeping chest drain in place.