Atrial septal defect, pediatric cardiac center delaware. The catheter technique involves closing the atrial septal defect asd with a synthetic device that plugs the hole. Now, device closure through a cardiac catheterization has become the first choice to repair secundum asds if certain criteria are met. Percutaneous closure of defect with amplatzer is the technique of choice in the most frequent form of asd secundum type but if this modality cannot be used because of the lack of borders in the foramen or failing the technique, invasive surgery is. A 3 cm diameter atrial septal defect was created, and closed with. An atrial septal defect asd is a congenital heart defect where there is a hole in the atrial septum, the wall which separates the right and left atria.
Pericarditis with atrial septal defect with bilateral. Another patch of bovine pericardium, slightly larger than the slit. A small opening between the two atria foramen ovale is always present at birth, but usually seals off shortly thereafter. Uw health heart, vascular and thoracic care doctors work with patients with atrial septal defect asd to determine the best course of treatment atrial septal defect repair. We present the case as it is a rare finding in our long experience. Surgical closure is more complicated compared to other atrial septal defect repairs. The most common is the ostium secundum, which arises within the boundaries of the fossa ovalis. Closure of an atrial septal defect with a oneway flap patch.
It is folded into a special delivery catheter, similar to the catheter used to cross the heart defect during catheterization. Ventricular septal defect vsd closure with an untreated autologous pericardial patch was performed in 102 children of mean age. A retrospective comparison of bovine pericardium and. A ventricular septal defect vsd is a defect in the septum between the right and left ventricle. This retrospective study compared the immediate postoperative first month and midterm up to 5 years postoperation results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene ptfe patch.
Pdf experience with autologous pericardial patch closure of. Asds account for between 5% and 10% of all cases of congenital heart disease and are twice as prevalent among girls as boys. Atrial septal defects ostium secundum, ostium primum, sinus venosus, and those associated with intracardiac total anomalous pulmonary venous connection and other complex defects often require closure by a patch. Us8398658b2 device and procedure for minimally invasive. Although patients with this defect are often asymptomatic until adulthood, potential complications of an untreated asd include atrial arrhythmias, paradoxical embolization, cerebral abscess, right ventricular failure, and pulmonary hypertension that can become irreversible and. Minimally invasive atrial septal defect asd closure. Device closure at catheterization has become increasingly popular while surgical closure primarily or with a patch tanned or treated pericardium can. A surgical device for closure atrial septal defect asd with minimally invasive approach and a transcatheter device for closure asd using pericardial patch includes a distal jaw that is distal relative to a person holding the device and a proximal jaw, a guide rod which drives the jaws to pass a pericardium patch through a patients asd and fix the pericardium patch onto an asd rim. Dec 23, 2017 surgical closure of atrial septal defects surgical repair of an atrial septal defect asd is a safe and effective operation with little to no morbidity and mortality. Sinus venosus asds are located outside of the oval fossa at the point of entry of the svc into the right. Mitral valve repair, closure of the cleft mitral leaflet, annuloplasty and mitral valve replacement may be required to.
Atrial septal defect asd is a common congenital anomaly and without repair can induce irreversible sequels in patients. Lyophilized glutaraldehyde preserved bovine pericardium lgpbp. Atrial septal defect asd is the most common congenital lesion in adults after bicuspid aortic valve. Although the procedure is invasive and has a shorter recovery duration and a lower complication rate compared with surgery, it is not riskfree.
It is a very common condition in which there is a hole between the two chambers of the heart known as the atria. Atrial septal defect nationwide childrens hospital. Surgical closure of atrial septal defects liavaa journal. Closure of an atrial septal defect with a oneway flap. The patch should be attached to the septum at the juncture of the mitral and tricuspid valves. Closure of secundum atrial septal defect requires cardiopulmonary bypass and aortic crossclamping. Surgical closure involves opening the atrium and closing the defect with a suture, patch or. Pericardium is an eminently suitable material for the closure of atrial septal defects.
Percutaneous closure of defect with amplatzer is the technique of choice in the most frequent form of asd secundum type but if this modality cannot be used because of the lack of borders in the foramen or failing the technique, invasive surgery is recommended. Asds constitute 8% of all congenital heart defects. An isolated atrial septal defect almost never causes clinically significant problems in the neonatal period or in infancy. Those who have palpitations or who faint need to be evaluated by their cardiologist and may need medical. Effect of transcatheter atrial septal defect closure in children on left ventricular diastolic function. Via femoral artery andor vein access, the septal occluder is passed into the atrial septal region. The lower part of the atrial septum fails to develop normally, leaving an opening between the atria. The present invention relates to a device and method for minimally invasive closure of atrial septal defect without cardiopulmonary bypass and, in particular, a device and a method for minimally invasive closure of atrial septal defect via a right minithoracotomy to deploy a pericardial patch under a transesophageal echocardiography guidance. Atrial septal defect the patient guide to heart, lung. Atrial septal defects nord national organization for rare. Robotically assisted atrial septal defect repair procedure. We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect asd using a glutaraldehydetreated autologous pericardial patch in the transcatheter interventional era.
Pericardial patch for atrial septal defect closure the. Proxicor tm for pericardial closure enables surgeons to reestablish the essential native anatomic structure of the pericardium proxicor for pericardial closure is used to restore the pericardium by providing a natural bioscaffold that allows the patients own cells to form a new pericardial layer. The catheter technique involves closure of the asd with a synthetic device that plugs the hole. Atrial septal defect asd american heart association. Even when the defect is discovered in adulthood, patients benefit from closure of large defects. In the normal heart, there are no holes or connections between the two atria. Outcomes of totally endoscopic atrial septal defect. A technique is described by which pericardium can be used to close atrial septal defects with minimal handling and assistance, and without chemical pretreatment. Atrial septal defects asds are holes in the atrial septum and account for 710% of all congenital heart defects chd, 3rd most common defect.
Transcatheter closure of secundum type atrial septal defect asd has become a standard procedure in most medical centers. Pdf experience with autologous pericardial patch closure. Atrial septal defect is a congenital condition and is not related with pericarditis or bilateral haemorrhagic ovarian cyst. An atrial septal defect asd is a hole in the part of the septum that separates the atria the upper chambers of the heart. Outcomes of totally endoscopic atrial septal defect closure. Especially large secundum atrial septal defects are closed with a patch of pericardium or synthetic material. The current guideline recommends asd closure for patients developing right atrial and ventricular enlargement regardless of the presence of symptoms class i and in those who have a history of paradoxical embolism or documented orthodeoxiaplatypnea class iia. A primum asd results from persistence of the ostium primum and is associated with atrioventricular canal defects. This hole allows oxygenrich blood from the left atrium to flow into the right atrium instead of flowing into the left ventricle as it should. The patch material may be a portion of the childs own pericardium the sac around the heart or a synthetic material. Surgical management for complications during closure of. The right atrium is opened, the defect is visualized, and it is closed primarily utilizing running monofilament suture.
Experiences in surgical closure of atrial septal defect. The pericardial patch is trimmed to appropriate size and sutured to the rim of the asd using a running polypropylene suture. Ventricular septal defect vsd american heart association. People with small unrepaired or repaired atrial septal defects rarely have any late problems. Since the early reports of surgical atrial septal defect asd closure in 1948 without direct visualization and in 1952 with hypothermia and inflow occlusion, over 50 years of surgical experience has resulted in an operation with minimal mortality or morbidity 1,2. If an asd is present, blood is able to freely flow through the hole from one atria to another. Some flow is a normal condition both prebirth and immediately postbirth via the foramen ovale.
However, when it is not treated with glutaraldehyde, it is difficult to handle because of curling in of the edges. A device for closure of an atrial septal defect asd by deploying a pericardial patch, said device comprising. Feb 16, 2017 a surgical device for closure atrial septal defect asd with minimally invasive approach and a transcatheter device for closure asd using pericardial patch includes a distal jaw that is distal relative to a person holding the device and a proximal jaw, a guide rod which drives the jaws to pass a pericardium patch through a patients asd and. Campbell m 1970 natural history of atrial septal defect.
Mitral valve repair, closure of the cleft mitral leaflet, annuloplasty and mitral valve replacement may be required to repair mitral insufficiency. A 69yrold previously healthy man with a history of atrial fibrillation and an atrial septal defect asd presented for asd closure and a maze procedure. Even though pericardium is a good material to use, many surgeons use a synthetic material because untreated pericardium is. Frequently, the valves that separate the atria from their respective ventricles tricuspid and mitral are also malformed, and the septum that divides the ventricles may also be deficient or. Closure of an atrial septal defect with a oneway flap patch in a patient with severe pulmonary hypertension milenko rosic.
Pericardial patch an overview sciencedirect topics. It is one of the most common heart defects in infants. However, when it is not treated with glutaraldehyde, it is dif. Doublelayer pericardial patch for atrial septal defect closure article in heart, lung and circulation 232 august 20 with 140 reads how we measure reads. The two patch technique uses a polytetrafluoroethylene ptfe patch or other patch material to close the vsd and autologous pericardium or other patch material to close the asd. Smaller defects are closed with sutures, whereas large defects require patches made of synthetic material or pericardium the lining of the heart.
If the secundum asd is too large or if the patient has any of the other types of asd, surgical closure is recommended. This type of procedure is performed by interventional. In some cases, asd may be closed interventionally through a closure device. Most atrial septal defects asds can be repaired by guiding a catheter through a blood vessel up into the heart. Septal defects are sometimes called a hole in the heart. Pericardial patch for atrial septal defect closure sanjeeth peter, mch dharmsinh desai memorial methodist institute of cardiology and cardiovascular surgery, gujarat, india pericardium is an eminently suitable material for the closure of atrial septal defects. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure.
Refer a child who is to have elective atrial septal defect surgical repair or transcatheter intervention to a pediatric center with experience in performing cardiopulmonary bypass and surgical atrial septal defect closure or catheter based procedures in. Symptomatic patients with partial defects and cardiac chamber herniation should undergo surgery. This prevents blood from flowing through the opening. Asd atrial septal defect asd stands for atrial septal defect. Today asds are closed using cardiopulmonary bypass cpb with direct vision of the lesion. Patients with secundum asd may opt for catheterbased asd closure. Although the defect often causes no symptoms until adulthood, potential complications of an undetected asd include atrial arrhythmias, paradoxical embolization, cerebral abscess, right ventricular rv failure, and pulmonary hypertension that can become irreversible and lead to. Surgical closure of the ostium primum asd requires. Atrial septal defect asd repair, heart and vascular care. It consists of two nitinol wire mesh discs filled with polyester fabric.
On transthoracic echocardiogram tte the patient had a mm defect in the inferoposterior part of the interatrial septum just above the tricuspid annulus with predominantly lefttoright. Surgical repair may involve either suture closure reserved for small asds or patch closure. The amplatzer septal occluder is a transcatheter closure device used to treat asds. The catheter is inserted into a vein in the leg, advanced. In an effort to reduce the trauma of surgery, current approaches focus on less invasive surgical techniques, rather than the intracardiac repair. The patch material may be a portion of the patients own pericardium the sac around the heart or a synthetic material. Pericardial patch for atrial septal defect closure. Asds are also part of many of the more complex forms of congenital heart disease. Experiences in surgical closure of atrial septal defect with. We are very pleased by the interest shown in our recent article describing a method for closure of an atrial septal defect asd with a oneway flap patch in a patient with severe pulmonary hypertension 1.
Options for surgical repair involve suture closure reserved for small asds or patch closure. The septum is a wall that separates the hearts left and right sides. A sinus venosus defect usually occurs high on the septum close to. Atrial septal defect asd is a congenital heart defect in which blood flows between the atria upper chambers of the heart. Atrial septal defect asd is a common congenital heart disease. Atrial septal defects nord national organization for.
As with an incomplete avsd, polyethylene terephthalate should be avoided because in the setting of avvr, hemolysis can occur. Ptfe patch or other patch material to close the vsd and autologous pericardium or other patch material to close the asd. Although sinus venosus atrial septal defect asd is a relatively simple congenital cardiac lesion, repair should be performed carefully to avoid obstruction of blood flow from the superior vena cava svc, associated anomalous rightsided pulmonary veins, or both of these structures. Its the most common congenital heart defect in the newborn. Doublelayer pericardial patch for atrial septal defect. An umbrellashaped device is then passed through the catheter into the defect.
577 812 466 91 773 596 610 1151 325 1488 1365 922 212 364 444 424 117 574 806 276 826 304 1425 157 580 850 521 1034 1241 229 1010 350