Atrial septal defect surgical closure: Difference between revisions
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In larger atrial septal defects, the atrium of the aorta can become distorted during closure. A superior defect, when closed directly, may result in an distortion of the aortic anulus. Instead, a synthetic patch made of Dacron or PTFE can be used to close the aorta. It is not recommended that synthetic patches be used for primary closure.<ref name="pmid15172284">{{cite journal| author=Hopkins RA, Bert AA, Buchholz B, Guarino K, Meyers M| title=Surgical patch closure of atrial septal defects. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 6 | pages= 2144-9; author reply 2149-50 | pmid=15172284 | doi=10.1016/j.athoracsur.2003.10.105 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15172284 }} </ref> | In larger atrial septal defects, the atrium of the aorta can become distorted during closure. A superior defect, when closed directly, may result in an distortion of the aortic anulus. Instead, a synthetic patch made of Dacron or PTFE can be used to close the aorta. It is not recommended that synthetic patches be used for primary closure.<ref name="pmid15172284">{{cite journal| author=Hopkins RA, Bert AA, Buchholz B, Guarino K, Meyers M| title=Surgical patch closure of atrial septal defects. | journal=Ann Thorac Surg | year= 2004 | volume= 77 | issue= 6 | pages= 2144-9; author reply 2149-50 | pmid=15172284 | doi=10.1016/j.athoracsur.2003.10.105 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15172284 }} </ref> | ||
Some atrial septal defects may have additional complications such as cleft mitral valves. This is | Some atrial septal defects may have additional complications such as cleft mitral valves. This is commonly found in [[Atrial septal defect ostium primum|ostium primum defects]]. In this situation, a surgical approach must address correcting both, the atrial septal defect and the cleft mitral valve. Procedures such as mitral valve repair, involving the closure of the cleft mitral leaflet, may be merited to address and prevent mitral insufficiency. Some patients, depending on the severity of mitral insufficiency, may require a full mitral valve replacement. | ||
In larger defects, it is essential to ensure the usage of a synthetic patch be placed strategically to allow anomalous pulmonary venous drainage, whereby blood is diverted from the left atrium. In this case, pulmonary venous return must be carefully monitored and assessed. Complications can arise resulting in localized pulmonary venous [[hypertension]]. | |||
==References== | ==References== | ||
Revision as of 14:26, 6 July 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Surgical therapy
Surgical closure of an ASD involves opening up at least one atrium and closing the defect.
General techniques for engaging in surgical closure include:
- Median sternotomy
- Right anterolateral submammary sub pectoral (most preferred in females)
Other minimally invasive approaches include:
- Upper hemisteronomy
- Right parasternal
- Right submammary bikini line (for females)
- Limited median sternotomy (for males)
- Transxiphoid sternotomy (for children or young adults)
It is advised that an anterolateral approach only be used in adults as it may damage prepubescent girls during development of breast tissue.
Surgical approaches for small atrial septal defects
In the case of a small atrial septal defect, a surgeon can perform a direct arterial and double venuous cannulation via a median sternotomy incision. Most small atrial septal defects can be repaired while the heart is under an a cardioplegia solution induced arrest utilizing a prolene suture.
Surgical approaches for larger atrial septal defects
In larger atrial septal defects, the atrium of the aorta can become distorted during closure. A superior defect, when closed directly, may result in an distortion of the aortic anulus. Instead, a synthetic patch made of Dacron or PTFE can be used to close the aorta. It is not recommended that synthetic patches be used for primary closure.[1]
Some atrial septal defects may have additional complications such as cleft mitral valves. This is commonly found in ostium primum defects. In this situation, a surgical approach must address correcting both, the atrial septal defect and the cleft mitral valve. Procedures such as mitral valve repair, involving the closure of the cleft mitral leaflet, may be merited to address and prevent mitral insufficiency. Some patients, depending on the severity of mitral insufficiency, may require a full mitral valve replacement.
In larger defects, it is essential to ensure the usage of a synthetic patch be placed strategically to allow anomalous pulmonary venous drainage, whereby blood is diverted from the left atrium. In this case, pulmonary venous return must be carefully monitored and assessed. Complications can arise resulting in localized pulmonary venous hypertension.
References
- ↑ Hopkins RA, Bert AA, Buchholz B, Guarino K, Meyers M (2004). "Surgical patch closure of atrial septal defects". Ann Thorac Surg. 77 (6): 2144–9, author reply 2149-50. doi:10.1016/j.athoracsur.2003.10.105. PMID 15172284.