Repair of Atrial Septal Defect through a Limited Right Anterolateral Thoracotomy in 242 Patients: A Cosmetic Approach?

2005 ◽  
Vol 6 (2) ◽  
pp. 16 ◽  
Author(s):  
Aristotelis Panos ◽  
Stefane Aubert ◽  
Gerald Champsaur ◽  
Jean Ninet
Keyword(s):  
Cosmetic Result ◽  
Superior Result ◽  
Anterolateral Thoracotomy ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
The Mean ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection ◽  
Good Exposure ◽  
New Instruments

<P>Background: The repair of atrial septal defects (ASD) is often safely performed as a routine procedure in the young and asymptomatic patient. The purpose of this study is to evaluate the feasibility and especially the cosmetic result of this repair performed through a limited right anterolateral thoracotomy (RALT), with the complete cannulation and aortic cross-clamping conducted through the same incision. </P><P>Methods: From January 1980 to June 2001 in our hospital, 242 patients (210 female) with atrial septal defects and a mean age of 26.2 � 12.0 years underwent operations through a RALT. Repaired defects included 235 ostium secundum defects and 7 sinus venosus defects with partial anomalous pulmonary venous connection (SV). Patients were contacted by phone to evaluate their satisfaction with the thoracic scar. </P><P>Results: There was neither operative nor early mortality. All of the mentioned defects were successfully corrected. Mean bypass times were 12.37 � 4.9 minutes for ASD defects and 47.5 � 6.4 minutes for SV defects. The mean stay in the intensive care unit was 1.3 � 0.5 days. Most of the patients (86.3%) were fully satisfied with the cosmetic result. </P><P>Conclusions: The right anterolateral thoracotomy incision provides a safe and effective approach for the correction of the ASD. This approach can be safely performed without any new instruments and without peripheral incisions, provides good exposure for the surgeon to work comfortably, and achieves a cosmetically superior result in selected cases.</P>

The Evolution of the Right Anterolateral Thoracotomy Technique for Correction of Atrial Septal Defects: Cosmetic and Functional Results in Prepubescent Patients

2013 ◽  
Vol 95 (1) ◽  
pp. 242-247 ◽  
Author(s):  
Vladimiro L. Vida ◽  
Chiara Tessari ◽  
Assunta Fabozzo ◽  
Massimo A. Padalino ◽  
Elisa Barzon ◽  
...  
Keyword(s):  
Functional Results ◽  
Anterolateral Thoracotomy ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
The Right

Persistent electrical and morphological atrial abnormalities after early closure of atrial septal defect

2004 ◽  
Vol 14 (5) ◽  
pp. 481-487 ◽  
Author(s):  
Clifford L. Cua ◽  
Elizabeth E. Sparks ◽  
David P. Chan ◽  
Curt J. Daniels
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pearson Correlation ◽  
P Wave ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Pr Interval ◽  
Early Closure ◽  
The Right

Atrial arrhythmias are associated with enlarged atrial chambers and an increased duration of the P wave. Repair of atrial defects within the oval fossa is expected to normalize atrial size. Few studies, however, have evaluated electrical and morphological atrial features after repair. Our study was performed to determine if atrial abnormalities exist after surgical closure of such atrial septal defects, and whether early closure improves outcome. We recruited patients who had undergone surgical closure of a defect within the oval fossa, so-called “secundum” atrial septal defects. Electrocardiograms, signal averaged electrocardiograms, and echocardiograms were performed. Two-tailed test and Pearson correlation was utilized for statistical analysis. The population consisted of 20 patients and 27 controls, with the mean age of the patient being 11.25 ± 5.10 years, their age at surgery 6.55 ± 5.10 years, and the time since surgery 4.70 ± 2.61 years. The size of the right (23.88 ± 6.35 ml/m2 versus 18.84 ± 4.43 ml/m2) and left (21.91 ± 12.47 ml/m2 versus 17.72 ± 4.83 ml/m2) atrium were significantly larger in the patients. The duration of the P wave (108 ± 16 ms versus 96 ± 8 ms) and the duration of the PR interval (155 ± 18 ms versus 138 ± 23 ms) were longer. No correlation existed between age or interval since surgery with atrial sizes or measurements of the signal averaged electrocardiogram. We conclude that, despite surgical repair, abnormalities exist in patients with an atrial septal defect. Early surgery does not appear to prevent the atrial abnormalities.

scholarly journals Utility of Eustachian valve for facilitating ASD device closures in defects with borderline mitral rims

2021 ◽  
Author(s):  
Harikrishnan Kurup ◽  
Arun Gopalakrishnan ◽  
Deepa Sasikumar ◽  
Venkatesh Gurajala ◽  
Kavasseri Krishnamoorthy
Keyword(s):  
Right Atrium ◽  
Device Closure ◽  
Eustachian Valve ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Device Deployment ◽  
The Right

A prominent Eustachian valve in the right atrium has been reported to pose significant challenges during device closure of atrial septal defects. We describe the procedural aspects of device closure in an ASD with deficient rims and a redundant Eustachian valve. The prominent Eustachian valve provided extra stability in the anteroinferior aspect during device deployment and hence proved to be helpful for the procedure. It is important to consider this aspect while planning device closure

Transcatheter Closure of Atrial Septal Defects

2018 ◽  
Author(s):  
Khoa Nguyen ◽  
Patrick Callahan
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Transcatheter Closure ◽  
Open Heart Surgery ◽  
Anatomy And Physiology ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
The Right

The term congenital heart disease encompasses a vast array of lesions that present unique anesthetic challenges. Making up close to 10% of all congenital heart disease, atrial septal defects are some of the more commonly encountered congenital lesions. Atrial chambers in the heart are separated by a septum that forms during embryological development. When the septum does not develop normally, blood communicates between the right and left atria. This alteration in flow has significant effects on both cardiac and pulmonary anatomy and physiology. Cardiothoracic surgery used to be the only way to close defects that did not spontaneously close. Transcatheeter device closure of atrial septal defects in the cardiac catheterization lab has become increasingly common and offers significant advantages over open heart surgery. This chapter highlights the anatomic and physiologic considerations of the different types of atrial septal defects and discusses the details of transcatheter closure including indications, timing, and risks.

Device Size for Transcatheter Closure of Ovoid Interatrial Septal Defect

2013 ◽  
Vol 16 (4) ◽  
pp. 193
Author(s):  
Eun Hyun Cho ◽  
Jinyoung Song ◽  
Eun Young Choi ◽  
Sang Yoon Lee
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Defect Group ◽  
Amplatzer Septal Occluder ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
The Mean ◽  
Computed Tomography Image ◽  
Device Size

<p><b>Background:</b> For successful transcatheter closure of an atrial septal defect with the Amplatzer septal occluder, the shape of the defect should be considered before selecting the device size. The purpose of this study was to evaluate the results of transcatheter closure of an ovoid atrial septal defect.</p><p><b>Methods:</b> Between January 2010 and February 2012, cardiac computer tomography examinations were performed in 78 patients who subsequently underwent transcatheter closure of an atrial septal defect. In this retrospective study, we reviewed these patients' medical records. We defined an ovoid atrial septal defect as a value of 0.75 for the ratio of the shortest diameter of the defect to the longest diameter, as measured in a computed tomography image. Transthoracic echocardiography examinations were made at 1 day and 6 months after the procedure.</p><p><b>Results:</b> Transcatheter closure of an atrial septal defect was successful in 26 patients in the ovoid-defect group and in 52 patients in the round-defect group. There were no serious complications in either group, and the rate of complete closure at 6 months was 92.3% in the ovoid-defect group and 93.1% in the round-defect group (<i>P ></i> .05). The mean (SD) difference between the device size and the defect's longest diameter, and the mean ratio of the device size to the longest diameter were significantly smaller in the ovoid-defect group (1.7 � 2.9 versus 3.8 � 2.5 and 1.1 � 0.1 versus 1.3 � 0.2, respectively).</p><p><b>Conclusions:</b> Transcatheter closure of an atrial septal defect is indicated even for an ovoid atrial septal defect. Ovoid atrial septal defects can be closed successfully with smaller sizes of the Amplatzer septal occluder than for round atrial septal defects.</p>

scholarly journals Ruptured and Non-Ruptured Sinus of Valsalva Aneurysms: Five Case Studies

2002 ◽  
Vol 30 (4) ◽  
pp. 457-462 ◽  
Author(s):  
A Ateş ◽  
İ Yekeler ◽  
A Özyazicioğlu ◽  
Ü Vural ◽  
M Yilmaz
Keyword(s):  
Coronary Sinus ◽  
Ductus Arteriosus ◽  
Outlet Obstruction ◽  
Left Ventricular ◽  
Sinus Of Valsalva ◽  
Septal Defects ◽  
Double Approach ◽  
The Mean ◽  
The Right

Between 1987 and 2000, we observed retrospectively a series of five cases of surgically treated sinus of Valsalva aneurysms (SVAs) at the Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey. The mean age of the five patients was 32.6 years (range, 18–48 years). Three were male and two were female. Aneurysms originated from the right coronary sinus in four patients, and from the non-coronary sinus in one. Three aneurysms fistulized to the right ventricle, one to the right atrium and the last, originating from the right coronary sinus, was non-ruptured. Two aortic insufficiencies, two ventricular septal defects, one patent ductus arteriosus and one left ventricular outlet obstruction were found as concomitant lesions. All cases were symptomatic. Ruptured SVAs were repaired by double approach involving both the chamber and aortic root. There was no late mortality either in the hospital or during the follow-up period (mean 40.4 months, range 13–66 months). No patient required re-operation.

Transthoracic three-dimensional echocardiography prior to closure of atrial septal defects in children

2003 ◽  
Vol 13 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Philippe Acar ◽  
Daniel Roux ◽  
Yves Dulac ◽  
Pierre Rougé ◽  
Yacine Aggoun
Keyword(s):  
Three Dimensional ◽  
Mean Difference ◽  
Complete Agreement ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Maximal Diameter ◽  
The Mean ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

Aims:Our aims were to use transthoracic three-dimensional echocardiography to assess the morphology of atrial septal defects in children prior to closure, and to compare the three-dimensional echocardiographic data with transcatheter and surgical findings.Methods and results:We used transthoracic three-dimensional echocardiography in 62 consecutive patients, aged from 2 to 18 years, with atrial septal defects, measuring the maximal diameter and the extent of the rims. Subsequent to the study, we referred 42 patients for transcatheter closure, the rims being measured at greater than 4 mm. We found a good correlation between the maximal diameter of the defect as measured at transthoracic three-dimensional echocardiography and using a balloon (y = 3.45 − 0.73x; r = 0.78; p < 0.0001), the mean difference between the measurements being 2.4 ± 2.8 mm. Successful closure with the Amplatzer septal occluder, having a mean size of 22 ± 4 mm, was achieved in 95% of the patients. Of the original cohort, 20 patients were referred for surgical closure. In these patients, the inferior rim had been deemed insufficient in 5, the postero-superior rim in 6, and the postero-inferior rim in 9. Complete agreement was found when the deficiency of the rim as judged using transthoracic three-dimensional echocardiography was compared with intraoperative findings. The correlation between measurements of the deficiency of the rim achieved by transthoracic three-dimensional echocardiography and at surgery was excellent (y = 0.2 + 0.98x; r = 0.93; p < 0.0001), the mean difference between the measurements being no more than 0.6 ± 0.4 mm.Conclusions:Transthoracic three-dimensional echocardiography proved accurate in measuring the maximal diameter and rims of atrial septal defects within the oval fossa. This non-invasive method will be valuable in selecting children for transcatheter or surgical closure of such defects.

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