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.