Atrial septal defect surgical closure
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Atrial Septal Defect Microchapters | |
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Treatment | |
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Surgery | |
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Atrial septal defect surgical closure On the Web | |
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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 most common treatment method for atrial septal defect patients and has been the gold standard for many years. Many surgeons prefer more minimally invasive techniques to avoid potential for additional complications. Special consideration must be taken into account for the age of the patient and the size of the defect involved.
Mechanisms of benefit
Surgical closure includes either putting a pericardial patch or direct suture closure. The decision for suture closure or patch closure depends on the morphology and size of defect. Small to moderate defects with oval shape can be closed with the help of sutures. Whereas, large round defects may require a patch closure. The patch can be either natural (made out of the patient's pericardium) or artificial (dacron). The closure of the defect prevents the shunting of blood across the atrium and thus correcting the condition. 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.
Indication
A sinus venosus, coronary sinus, or primum ASD should be repaired surgically rather than 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
ACC/AHA recommendations for interventional and surgical therapy
Surgical approaches
Post-surgical complications
Prognosis
Early mortality is approximately 1% in the absence of PAH or other major comorbidities. Long-term follow-up is excellent, and preoperative symptoms decrease or abate. The incidence of atrial fibrillation/flutter is reduced when concomitant antiarrhythmic procedures (eg, Maze) are performed; however, atrial arrhythmias may occur de novo after repair.The need for reoperation of residual/recurrent ASD is uncommon. Superior vena cava stenosis or pulmonary vein stenosis may occur after closure of sinus venosus ASD.