Atrial septal defect surgical closure: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Early mortality is approximately 1% in the absence of | Early mortality is approximately 1% in the absence of [[pulmonary hypertension]] 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 atrial septal defect|sinus venosus]] [[ASD]]. | ||
==See also== | ==See also== | ||
Revision as of 23:27, 3 September 2011
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Atrial Septal Defect Microchapters | |
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Treatment | |
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Surgery | |
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Special Scenarios | |
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Case Studies | |
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Atrial septal defect surgical closure On the Web | |
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American Roentgen Ray Society Images of Atrial septal defect surgical closure | |
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Risk calculators and risk factors for Atrial septal defect surgical closure | |
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 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 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.
- Small to moderate defects with oval shape, can be closed with the help of sutures.
- Large round defects may require a patch closure.
- The patch can be made up of either natural (made out of the patient's pericardium) or artificial (dacron) material.
- 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
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
ACC/AHA recommendations for interventional and surgical therapy
Surgical approaches
Post-surgical complications
Prognosis
Early mortality is approximately 1% in the absence of pulmonary hypertension 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.