Atrial septal defect surgical closure: Difference between revisions
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[[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== | |||
[[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== | |||
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== | ||
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* 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. | * 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 | * 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 [[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]]. | ||
==[[Atrial septal defect ACC/AHA guidelines for interventional and surgical therapy|ACC/AHA recommendations for interventional and surgical therapy]]== | ==[[Atrial septal defect ACC/AHA guidelines for interventional and surgical therapy|ACC/AHA recommendations for interventional and surgical therapy]]== | ||
Revision as of 13:26, 11 September 2011
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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 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%
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.
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.
See also
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.