Abstract

Minimally invasive cardiac surgery (MICS) has become a standard and preferred approach for the surgical closure of atrial septal defects (ASDs) due to its reduced surgical trauma, faster recovery, and improved cosmetic outcomes.1-2 However, certain patient factors can pose significant challenges to this technique. In particular, patients who have previously undergone unsuccessful percutaneous device closure attempts may present additional complexities, such as vascular access issues from prior femoral puncture. Furthermore, the presence of chest wall deformities like pectus excavatum can complicate surgical exposure and instrument maneuverability, making MICS relatively contraindicated in these cases. This report presents a case of minimally invasive closure of an ostium secundum ASD in a patient with both pectus excavatum and a history of failed device closure. We detail the intraoperative challenges encountered, including limited access and altered anatomy, and discuss the strategies employed to overcome these hurdles, emphasizing the importance of careful patient selection and tailored surgical planning.

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