Anomalous left hepatic vein to coronary sinus in a patient with atrial septal defect : Minimally invasive approach ; Technical challenges

Left hepatic vein draining into coronary sinus is a rare systemic vascular anomaly. Its presence is significant when it is associated with other cardiac lesions requiring surgery. We report technical challenges in a case of persistent left superior vena cava and left hepatic vein draining into coronary sinus in an adult with ostium secundum atrial septal defect, which was repaired through minimally invasive approach. Main technical challenge in this case was to achieve adequate venous drainage, which was achieved by vacuum assistance and by manipulating the position of femoral venous cannula. We approached through right anterolateral thoracotomy, adequate venous drainage was achieved without cannulating left hepatic vein or left superior vena cav.