Atrial Septal Defects

Suvro S. Sett MD The Maria Fareri Childrens Hospital New York Medical College March 2011

Atrial Septal Defects

Embryology Secundum atrial septal defect Sinus venosus atrial septal defect Coronary sinus atrial septal defect

Atrial Septal Defect

Pathophysiology Left-to-right shunt Probe patent foramen ovale

Atrial Septal Defect

Diagnoses CXR Echocardiography MRI Diagnostic cardiac catheterization

Atrial Septal Defect

Intervention Timing of repair Percutaneous closure

Atrial Septal Defect

Incisions and approaches Median sternotomy Minimally invasive median sternotomy Right axillary thoracotomy Right lateral thoracotomy Bilateral submammary incision Robotic surgery

A small incision across two intercostal spaces is performed (3 to 8 cm)

Khan J. H. et al.; Ann Thorac Surg 1998;66:1433-1435

Copyright 1998 The Society of Thoracic Surgeons

A pursestring suture in the right atrial appendage is used to retract the appendage inferiorly and provide exposure of the aorta

Khan J. H. et al.; Ann Thorac Surg 1998;66:1433-1435

Copyright 1998 The Society of Thoracic Surgeons

Standard aortic cannulation is used

Khan J. H. et al.; Ann Thorac Surg 1998;66:1433-1435

Copyright 1998 The Society of Thoracic Surgeons

Postoperative result of the skin incision used in conjunction with a groin incision for the correction of an abnormal return of the right upper pulmonary veins

Pretre R. et al.; J Thorac Cardiovasc Surg 2005;130:277-281

Copyright 2005 The American Association for Thoracic Surgery

The series of photographs demonstrate incisions after closure of secundum atrial septal defect utilizing the adult female surgical aproach as described in the methods

Hopkins R. A. et al.; Ann Thorac Surg 2004;77:2144-2149

Copyright 2004 The Society of Thoracic Surgeons

Atrial Septal Defect

Sinus venosus ASD Coronary sinus ASD without LSVC Coronary sinus ASD with LSVC to roof of left atrium with unroofed coronary sinus

Atrial Septal Defect

Atrial septal defects associated with symptoms in infancy Atrial septal defects in adults

Atrial Septal Defect

Closure of atrial septal defects should be associated with mortality and morbidity rates which are minimal Post pericardiotomy syndrome may be seen in up to 5% of patients

Atrial Septal Defect

References Jonas RA Comprehensive surgical management of congenital heart disease Atrial septal defect Arnold 2004 p225-241 Mainwaring RD and Lamberti JJ Atrial septal defects in Mastery of Cardiothoracic Surgery Kaiser LR, Kron IL, Spray TL editors Lippincott-Raven 1998 p677-686 Khan JH McElhinney D Reddy VM Hanley FL Repair of secundum atrial septal defect: Limiting the incision without sacrificing exposure Ann Thor Surg 1998;66:1433-1435 Pretre R et al Right axillary incision: A cosmetically superior approach to repair a wide range of congenital cardiac defects J Thor Cardiovasc Surg 2005;130;277-281 Hopkins RA Surgical patch closure of atrial septal defects Ann Thor Surg 2004;77:2144-2149