An atrial septal defect of the inferior vena caval type presents complicated anatomy to the surgeon at operation. Four cases are presented illustrating two complications of repair. Incomplete closure or reopening due to disruption of the suture line may be prevented by accurate identification of the anatomy and a patch closure. Two cases of inadvertent diversion of the inferior vena cava into the left atrium are presented and the methods of diagnosis and techniques of repair are discussed. Mitral regurgitation due to ballooning of the posterior cusp in systole was an associated lesion in two cases of atrial septal defect of this type.
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