Atrial septal defect surgical closure: Difference between revisions
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[[Atrial septal defect surgical closure | Surgical closure]] is the commonest treatment method for [[atrial septal defect]] and has been the gold standard for many years. Many surgeons prefer more [[minimally invasive surgery|minimally invasive techniques]] over the conventional [[sternotomy]] to avoid potentials for additional complications. Special consideration must be taken into account for the age of the patient and the size of the defect involved. Surgical closure is indicated for patients with [[Atrial septal defect ostium primum|primum]], [[Atrial septal defect sinus venosus|sinus venosus]] and [[Atrial septal defect coronary sinus | coronary sinus]] type of [[atrial septal defect]]s. However, [[Ostium secundum atrial septal defects|ostium secundum]] [[atrial septal defect]]s are commonly treated by [[Percutaneous atrial septal defect|percutaneous closure]]. With uncomplicated [[atrial septal defect]], (without [[pulmonary hypertension]] and other comorbidities) the post-surgical mortality is as low as 1% | [[Atrial septal defect surgical closure | Surgical closure]] is the commonest treatment method for [[atrial septal defect]] and has been the gold standard for many years. Many surgeons prefer more [[minimally invasive surgery|minimally invasive techniques]] over the conventional [[sternotomy]] to avoid potentials for additional complications. Special consideration must be taken into account for the age of the patient and the size of the defect involved. Surgical closure is indicated for patients with [[Atrial septal defect ostium primum|primum]], [[Atrial septal defect sinus venosus|sinus venosus]] and [[Atrial septal defect coronary sinus | coronary sinus]] type of [[atrial septal defect]]s. However, [[Ostium secundum atrial septal defects|ostium secundum]] [[atrial septal defect]]s are commonly treated by [[Percutaneous atrial septal defect|percutaneous closure]]. With uncomplicated [[atrial septal defect]], (without [[pulmonary hypertension]] and other comorbidities) the post-surgical mortality is as low as 1% | ||
==Mechanisms of benefit== | ==Surgery== | ||
===Mechanisms of benefit=== | |||
[[Atrial septal defect surgical closure | Surgical closure]] involves closing the defect either by putting a [[pericardial]] patch or via direct suture closure. The decision for suture closure or patch closure depends on the morphology and size of defect. The closure of the defect prevents the [[left-to-right shunt]]ing of blood across the [[atrium]] and thus improving the circulation in heart. 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>. | [[Atrial septal defect surgical closure | Surgical closure]] involves closing the defect either by putting a [[pericardial]] patch or via direct suture closure. The decision for suture closure or patch closure depends on the morphology and size of defect. The closure of the defect prevents the [[left-to-right shunt]]ing of blood across the [[atrium]] and thus improving the circulation in heart. 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>. | ||
==Indication== | ===Indication=== | ||
[[Atrial septal defect surgical closure|Surgical closure]] is indicated for patients with [[Atrial septal defect ostium primum|primum]], [[Atrial septal defect sinus venosus|sinus venosus]] and [[Atrial septal defect coronary sinus | coronary sinus]] type of [[atrial septal defect]]s. Whereas, [[Ostium secundum atrial septal defects|ostium secundum]] [[atrial septal defect]]s are commonly treated by [[Percutaneous atrial septal defect|percutaneous closure]]. | [[Atrial septal defect surgical closure|Surgical closure]] is indicated for patients with [[Atrial septal defect ostium primum|primum]], [[Atrial septal defect sinus venosus|sinus venosus]] and [[Atrial septal defect coronary sinus | coronary sinus]] type of [[atrial septal defect]]s. Whereas, [[Ostium secundum atrial septal defects|ostium secundum]] [[atrial septal defect]]s are commonly treated by [[Percutaneous atrial septal defect|percutaneous closure]]. | ||
==Contraindications== | ===Contraindications=== | ||
Surgery is contraindicated in patients with severe irreversible [[Pulmonary hypertension|pulmonary artery hypertension]], [[eisenmenger's syndrome]] and no evidence of a [[left-to-right shunt]]. Also, for uncomplicated cases with [[ostium secundum atrial septal defect|ostium secundum defects]] percutaneous closure are preferred | Surgery is contraindicated in patients with severe irreversible [[Pulmonary hypertension|pulmonary artery hypertension]], [[eisenmenger's syndrome]] and no evidence of a [[left-to-right shunt]]. Also, for uncomplicated cases with [[ostium secundum atrial septal defect|ostium secundum defects]] percutaneous closure are preferred | ||
==General considerations during surgery== | ===General considerations during surgery=== | ||
* Small to moderate defects with oval shape, can be closed with the help of sutures. | * Small to moderate defects with oval shape, can be closed with the help of sutures. | ||
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* Other operations that are done for anomalies associated with atrial septal defects are [[tricuspid valve]] repair for significant [[tricuspid regurgitation]], repair for [[Total anomalous pulmonary venous connection|anomalous pulmonary venous drainage]], Warden procedure (translocation of the superior vena cava to the right atrial appendage) for sinus venosus ASD when the [[Total anomalous pulmonary venous connection|anomalous pulmonary venous drainage]] enters the mid or upper [[superior vena cava]] and [[maze procedure]] for intermittent/chronic [[atrial fibrillation]]/[[flutter]]. | * Other operations that are done for anomalies associated with atrial septal defects are [[tricuspid valve]] repair for significant [[tricuspid regurgitation]], repair for [[Total anomalous pulmonary venous connection|anomalous pulmonary venous drainage]], Warden procedure (translocation of the superior vena cava to the right atrial appendage) for sinus venosus ASD when the [[Total anomalous pulmonary venous connection|anomalous pulmonary venous drainage]] enters the mid or upper [[superior vena cava]] and [[maze procedure]] for intermittent/chronic [[atrial fibrillation]]/[[flutter]]. | ||
* Devices used are: | |||
** Amplatzer septal occluder | |||
** STARFlex septal occluder | |||
** PFO Star | |||
** HELEX | |||
==[[Atrial septal defect video showing surgical repair|Video: Surgical closure of atrial septal defect]]== | ==[[Atrial septal defect video showing surgical repair|Video: Surgical closure of atrial septal defect]]== | ||
Revision as of 17:07, 11 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Surgical closure is the commonest treatment method for atrial septal defect and has been the gold standard for many years. Many surgeons prefer more minimally invasive techniques over the conventional sternotomy to avoid potentials for additional complications. Special consideration must be taken into account for the age of the patient and the size of the defect involved. Surgical closure is indicated for patients with primum, sinus venosus and coronary sinus type of atrial septal defects. However, ostium secundum atrial septal defects are commonly treated by percutaneous closure. With uncomplicated atrial septal defect, (without pulmonary hypertension and other comorbidities) the post-surgical mortality is as low as 1%
Surgery
Mechanisms of benefit
Surgical closure involves closing the defect either by putting a pericardial patch or via direct suture closure. The decision for suture closure or patch closure depends on the morphology and size of defect. The closure of the defect prevents the left-to-right shunting of blood across the atrium and thus improving the circulation in heart. It is not recommended that synthetic patches be used for primary closure.[1].
Indication
Surgical closure is indicated for patients with primum, sinus venosus and coronary sinus type of atrial septal defects. Whereas, ostium secundum atrial septal defects are commonly treated by percutaneous closure.
Contraindications
Surgery is contraindicated in patients with severe irreversible pulmonary artery hypertension, eisenmenger's syndrome and no evidence of a left-to-right shunt. Also, for uncomplicated cases with ostium secundum defects percutaneous closure are preferred
General considerations during surgery
- Small to moderate defects with oval shape, can be closed with the help of sutures.
- Direct suture closure of large round defects may cause distortion of the atrium and aortic annulus. Thus, a patch closure is preferred in these cases.
- The patch can be made up of either natural (made out of the patient's pericardium) or artificial polytetrafluoroethylene, (dacron).
- Other operations that are done for anomalies associated with atrial septal defects are tricuspid valve repair for significant tricuspid regurgitation, repair for anomalous pulmonary venous drainage, Warden procedure (translocation of the superior vena cava to the right atrial appendage) for sinus venosus ASD when the anomalous pulmonary venous drainage enters the mid or upper superior vena cava and maze procedure for intermittent/chronic atrial fibrillation/flutter.
- Devices used are:
- Amplatzer septal occluder
- STARFlex septal occluder
- PFO Star
- HELEX
Video: Surgical closure of atrial septal defect
ACC/AHA recommendations for interventional and surgical therapy
Post-surgical follow up
Post-surgical complications
Prognosis
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.