A Hidden Scar, A Visible Cure: Minimally Invasive Repair of ASD and Pulmonary Stenosis Without Femoral Bypass

Introduction: Atrial septal defect (ASD) with concurrent pulmonary stenosis (PS) is a rare congenital cardiac anomaly that presents functional and cosmetic challenges, especially in young female patients. Traditional surgical approaches via median sternotomy, while effective, may result in significant scarring and longer recovery times. Minimally invasive techniques have emerged as a preferred alternative, offering reduced morbidity and improved aesthetic outcomes.Case Presentation: A 20-year-old female presented with a large secundum ASD and severe valvular pulmonary stenosis. Due to her age and cosmetic concerns, she underwent surgical repair via a right anterolateral mini-thoracotomy using a 3-inch submammary incision. Cardiopulmonary bypass was established through conventional central aorto-caval cannulation, avoiding femoral access. The ASD was closed with a Dacron patch, and pulmonary valvotomy was performed through the right ventricular outflow tract and pulmonary artery. The procedure was completed without complications, and the patient had an uneventful recovery with excellent cosmetic and functional outcomes.Conclusion: This case highlights the feasibility, safety, and advantages of combining central cannulation with a minimally invasive mini-thoracotomy approach in the surgical correction of complex congenital heart defects. It offers a resource-efficient, cosmetically superior alternative to sternotomy, especially suited for young female patients and low-resource settings.