{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:15:59Z","timestamp":1788243359559,"version":"build-2803163510"},"reference-count":14,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Single atrium is a rare congenital heart defect typically repaired in infancy. Unrepaired adults with pregnancy face high risk, and postpartum repair with delayed sternal closure (DSC) has rarely been reported. Methods: We present a 33-year-old multiparous woman who presented at 30 weeks + 1 day of gestation with progressive dyspnea. Transthoracic echocardiography (TTE) revealed a single atrium with a common atrioventricular valve and an estimated pulmonary artery systolic pressure (PASP) of 47 mmHg. The multidisciplinary team advised early cesarean section, which was performed at 30 weeks + 3 days of gestation, but postpartum symptoms persisted. Six months later, the patient underwent surgical correction. The procedure was converted from right subaxillary mini-thoracotomy to median sternotomy due to intraoperative aortic dissection, which was repaired. The single atrium was partitioned using a bovine pericardial patch. Due to myocardial edema and hemodynamic instability, the sternum was left open and closed on postoperative day 4. She required 8 days of mechanical ventilation and 13 days of intensive care, and was discharged on day 27. Results: Surgical repair was successful, and at the 6-month postoperative follow-up, she had achieved NYHA class I functional status, with an estimated PASP of 40 mmHg and a well-positioned baffle with no residual shunt. Conclusions: This case demonstrates that multidisciplinary collaboration is essential for pregnant patients with unrepaired congenital heart disease, postpartum surgical correction is feasible with careful perioperative planning, and DSC is a safe strategy for managing hemodynamic instability in complex cardiac cases.<\/jats:p>","DOI":"10.3390\/jcm15176732","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6732","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single Atrium Repair with Delayed Sternal Closure in a Postpartum Multiparous Woman: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Jianing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210008, China"},{"name":"Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China"},{"name":"Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1251-0547","authenticated-orcid":false,"given":"Huimin","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China"},{"name":"Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210008, China"},{"name":"Department of Thoracic and Cardiovascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China"},{"name":"Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1055\/s-0039-3402765","article-title":"Single Atrium and Miscarriages","volume":"9","author":"Kojqiqi","year":"2020","journal-title":"Thorac. Cardiovasc. Surg. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4250\/jcu.2016.24.3.243","article-title":"Well-Tolerated and Undiscovered Common Atrium until Late Adulthood","volume":"24","author":"Kim","year":"2016","journal-title":"J. Cardiovasc. Ultrasound"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1111\/j.1747-0803.2008.00180.x","article-title":"Single Atrium Associated with Persistent Left Superior Vena Cava in Asymptomatic Adult: Case Report and Review of Literature","volume":"3","author":"Hasanin","year":"2008","journal-title":"Congenit. Heart Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1161\/CIRCULATIONAHA.114.009029","article-title":"Cardiovascular Physiology of Pregnancy","volume":"130","author":"Sanghavi","year":"2014","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sun, T., Che, H., Zhang, J., Lv, Y., Liu, Y., Liu, D., Wu, J., Wang, S., and Zhao, L. (2025). Maternal Outcomes among Pregnant Women with Shunt-Related Congenital Heart Disease-Associated Pulmonary Hypertension: A Retrospective Study. BMC Anesthesiol., 25.","DOI":"10.1186\/s12871-025-03082-2"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lv, C., Huang, Y., Liao, G., Wu, L., Chen, D., and Gao, Y. (2023). Pregnancy Outcomes in Women with Pulmonary Hypertension: A Retrospective Study in China. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05353-7"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2200879","DOI":"10.1183\/13993003.00879-2022","article-title":"2022 ESC\/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension","volume":"61","author":"Humbert","year":"2023","journal-title":"Eur. Respir. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2813","DOI":"10.1053\/j.jvca.2020.02.053","article-title":"Eisenmenger Syndrome in Pregnancy: A Management Conundrum","volume":"34","author":"Lopez","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/1753495X16678487","article-title":"A Case of Successfully Managed Pregnancy in a Patient with Complex Cyanotic Congenital Heart Disease","volume":"10","author":"Liu","year":"2017","journal-title":"Obstet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4103\/jcecho.jcecho_64_19","article-title":"Three-Chambered Heart (Single Atrium)\u2014A Rare Entity","volume":"30","author":"Garg","year":"2020","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/1471-0528.17474","article-title":"Management and Outcomes of Pulmonary Artery Hypertension and Eisenmenger Syndrome during Pregnancy: A Prospective Observational Cohort Study","volume":"130","author":"Jha","year":"2023","journal-title":"BJOG"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1017\/S1047951113000711","article-title":"Short- and Mid-Term Results of Xenograft-Bovine Pericardial Patch in the Repair of Intracardiac Defects: Final Results of a Single-Centre Study","volume":"24","author":"Yaliniz","year":"2014","journal-title":"Cardiol. Young"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1186\/s13019-025-03729-8","article-title":"Impact of Delayed Sternal Closure and Negative Pressure Therapy after Complex Cardiovascular Surgery","volume":"20","author":"Moreno","year":"2025","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.athoracsur.2024.04.031","article-title":"Delayed Sternal Closure vs Emergency Sternal Reopening in Adults With Congenital Heart Disease","volume":"118","author":"Abdelrehim","year":"2024","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6732\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:55:15Z","timestamp":1788242115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":14,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176732"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176732","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]}}}