Outcomes of totally endoscopic atrial septal defect closure using a glutaraldehydetreated autologous pericardial patch. The purpose of this study is to determine the incidence of pps after surgical repair of secundum asd and investigate what risk. Repair of primum asd with cleft mitral valve sciencedirect. Augmenting the patients own pericardium to assist in closure following openheart surgery.
Then repeat the valsalva to assess for leaks at teh patch. In some instances the surgeon is able to close the hole without a patch by simply drawing the edges together. Atypical atrial flutter after surgical correction of. Pericardial patch for atrial septal defect closure. The svcra junction may be augmented with pericardial patch to avoid svc obstruction. Atrial septal defect asd american heart association. Bovine pericardial patches are available in different sizes and shapes. Suitability for nonsurgical closure and technique of transcatheter closure of asds with the amplatzer occluders has been previously described. An atrial septal defect asd is a hole between the two upper chambers of the heart. Three years before admission the patient underwent surgical repair of atrial septal defect asd by pericardial patch closure of asd. The defect was closed primarily in 82 patients and with an autologous pericardial patch in 9 patients. Outcomes of totally endoscopic atrial septal defect closure.
However, when it is not treated with glutaraldehyde, it is dif. Our surgery group is one of the nations leading programs, with more than 600 openheart surgery procedures each year. Atrial septal defect asd is a common congenital heart disease. Atrial septal defect surgical repair pediatric heart. Ventricular septal defect vsd closure with an untreated autologous pericardial patch was performed in 102 children of mean age. Minimally invasive asd repair with limited resources ctsnet. Postpericardiotomy syndrome pps after cardiac surgery has a reported incidence of 140 %. Closure of an atrial septal defect with a oneway flap patch in a patient with severe pulmonary hypertension milenko rosic. Methods patients and study design between june 2011 and april 2015, 37 consecutive patients underwent surgical closure for asd using a glutaraldehydetreated autologous pericardial patch with a totally endoscopic minimally invasive approach at sakakibara. Atrial baffle procedure nonmustard, nonsenning medical. In contrast to percutaneous atrial septal occluder device, surgical patch closure of atrial septal defects was known to be associated with no infective endocarditis risk 2.
Pericardial patch closure of an atrial septal defect using. To learn more asd and the technology we use, please visit. Pericardial patch closure of an atrial septal defect. We focused exclusively on secundum asd repair to evaluate the incidence of pps. Surgical patch closure of atrial septal defects the annals of. The prognosis after asd closure during childhood is excellent and late complications are uncommon. Atrial septal defect asd for parents nemours kidshealth. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The asd closure minimally invasive procedure that repairs the asd with a small patch of pericardial tissue from your heart. Nonsurgical closure of asds has been achieved via cardiac catheterization. The patch either the patients own pericardial tissue or a synthetic graft is then stitched onto the hole in the septum to close it.
Billing open septal defect repair codes with 9358093581. Atrial septal defect asd repair, heart and vascular care. An atrial septal defect asd is a hole in the septum, or muscular wall, that separates the hearts two upper chambers atria. Surgical repair for atrial septal defects asd generally occurs during childhood. As pt is valsalvad once the bubbles resolve, then pull the suture tight and tie the knot. 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. Pericardial patch closure of an atrial septal defect using endoscopic robotic technology. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect asd using a combination of the davinci surgical system intuitive surgical, sunnyvale, ca, usa and the port access system cardiovations, sommerville, nj, usa for full cardiopulmonary bypass cpb.
Extracorporeal life support organization ecmo and ecls. Once the patch is sutured into place and the hole is closed, the patient is removed from cardiopulmonary. Doublelayer pericardial patch for atrial septal defect closure. 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. Muscular ventricular septal defect vsd is a congenital heart conditions that can affect blood flow in your childs heart. Gluteraldehyde treatment prevents patch shrinkage and aneurysm formation. Surgical patent foramen ovale closure for prevention of. Apr 12, 2018 a bovine pericardial patch was used to close the asd, using a running 50 prolene suture. This was previously reported in patients with pericardial patch, dacron patch, and the amplatzer closure device 11,12. We report here the case of a patient with history of syncope and dizziness.
Pdf experience with autologous pericardial patch closure of. Sep 30, 2014 in first cases, we closed asd directly but because we had a case with detachment of asd closure in suture lines, now we almost always use a pericardial patch for the closure of asd. Pericardial patch closure of an atrial septal defect using endoscopic. Some defects were closed with a patch of pericardium the normal lining outside the. Operative correction typically involves patch closure of the septal defect and closure of the left atrioventricular valve cleft. Bicaval occlusion, exposure and pericardial patch closure. 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. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect asd using a combination of the davinci surgical system intuitive surgical, sunnyvale, ca, usa and the port access system cardiovations, sommerville, nj. The pericardial patch is folded like an umbrella or clamshell within a special catheter. Cardiovascular patch, animalderived a sterile implantable material designed to reinforce suture lines andor increase the strength of weak or injured cardiac andor peripheral vascular tissues during cardiovascular repairreconstruction procedures e.
Patch closure with pericardium was used in all cases. A device for closure of an atrial septal defect asd by deploying a pericardial patch, said device comprising. Primum atrial septal defect asd is a common congenital cardiac anomaly that is typically repaired in the first years of life. Followup echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. Indications surgifoc pericardial patches are intended to be used for intracardiac repair, great vessel repair, pericardial closure and soft tissue repair as. Her echocardiogram showed no residual asd, good biventricular function and normal pulmonary artery pressures. Some flow is a normal condition both prebirth and immediately postbirth via the foramen ovale. Cryoablation of the intercostal nerves two interspaces above and two interspaces below the incision and liposomal bupivacaine injections were performed for postoperative analgesia.
Suturing of the bovine pericardial patch was performed on the 75% of its circumference. 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. The remaining patients had pericardial patch closure. 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.
A 24 year old woman presented for recommendations regarding anticoagulation management in the setting of a desire for future pregnancy. This catheter is then threaded into the left atrium, where the umbrellalike patch is opened and drawn against the atrial septum. The pericardial patch is finally detached and seated on the defect by gentle traction on both ends of the suture c. Closed surgically with autologous pericardial patch on 4th december 2015. The prognosis after asd closure during childhood is excellent and late. Smaller asds can simply be closed using a suture and oversewing the hole. At childrens national heart institute, we use advanced catheterization procedures to close these holes. The operation to repair an asd is performed under general anesthesia, which means you will be asleep during surgery.
Transcatheter closure of atrial septal defects cardiac. Outcomes of totally endoscopic atrial septal defect. Closure of an atrial septal defect with a oneway flap patch in a patient with severe pulmonary hypertension. The figure illustrates closure of the defect when a midline sternotomy is used, but the technique is possible with a parasternal or a small right submammary incision. It is common in patients with a congenital atrial septal. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect. For larger asds, a patch is usually used to close the hole. 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. Edwards lifesciences, the longestablished bovine tissue technology leader, provides the edwards bovine pericardial patch designed for a variety of applications including. Gluteraldehydetreated crimped bovine pericardial patches are highly preferred in the cardiovascular surgeries mainly in aortic replacement.
May 01, 2017 nishida h, nakatsuka d, kawano y, hiraiwa n, takanashi s, tabata m. Usually closing an asd is relatively straightforward. Mar 24, 2016 22 years old male having asd secondum of size 2740 mm. Totally endoscopic asd closure with a glutaraldehydetreated autologous pericardial patch demonstrated excellent outcomes. In most cases, asds are diagnosed and treated successfully with few or no complications. In first cases, we closed asd directly but because we had a case with detachment of asd closure in suture lines, now we almost always use a pericardial patch for the closure of asd. The ostium primum asd is closed by placing a series of horizontal mattress sutures on the rightward aspect of the crest of the ventricular septum, through the midpoint of the two avv orifices, and then through the autologous pericardial patch. The heart is closed with sutures, and the cardiopulmonary bypass machine is removed. Jun 25, 2008 pericadial patch closure of asd secundum on nomothermic beating heart.
Once finalized, the lsvc was baffling with a single pericardial patch toward the right atrium and with the same single pericardial patch the asd was closed hope this helps. Nishida h, nakatsuka d, kawano y, hiraiwa n, takanashi s, tabata m. This patch can be taken from the pericardium the sac that surrounds the heart or from synthetic materials such as dacron or teflon. Pediatric vsd closure devices childrens national hospital.
Secundum atrial septal defects asds account for 10% of congenital heart disease in neonates at birth and as much as 30% to 40% in adults. If the defect is particularly large, surgery is required. Surgical patch closure of atrial septal defects request pdf. An asd occurs when part of the atrial septum does not form properly. Your surgeon will use endoscopic instruments to patch the defect between the left and right atrium. Experiences in surgical closure of atrial septal defect. 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.
Before the patch closure is completed, attention is directed to the lavv. After deairing of left atrium from the last suture, atrium closure and deairing of ascending aorta from the insertion point of cardioplegia and declamping of. The surgeon uses suture material to stitch the pericardial patch into place. The surgical repair of atrial septal defects asd with or without a patch has been performed for approximately 60 years but the ideal material for closure is still. Atrial septal defect asd is a congenital heart defect in which blood flows between the atria upper chambers of the heart. Atrial septal defects congenital cardiac anesthesia society. She underwent surgical closure of a secundum asd with a bovine pericardial patch 26 months prior to presentation. However, many defects that required surgery may have been sewn closed without using a patch. An atrial septal defect asd sometimes called a hole in the heart is a type of congenital heart defect in which there is an abnormal opening in the dividing wall between the upper filling chambers of the heart the atria. Patients are supported by a heartlung machine intraoperatively and the asd is approached through an opening in the right atrium figure 1 open asd. A warden procedure may be necessary when the pv drains into the high svc or if there is difficulty making an unobstructed.
Surgical repair of asds is a well established procedure and is very safe, with a negligible mortality rate. The atrium is closed in two layers with a 40 prolene suture. Safety and feasibility of transseptal puncture for atrial. One patient had a residual righttoleft shunt after prior patch closure of an asd done elsewhere. Learn more information about atrial septal defect from the no. Atrial septal defect asd is one of the most common congenital cardiac diseases. Recurrent syncope was a result of sss and this syndrome rarely occurs after surgical patch closure of asd. Syncope due to sinus node dysfunction after surgical patch. Minimally invasive atrial septal defect asd closure. Surgical closure of atrial septal defects liavaa journal of. Thickness, shape, and the presence of calcifications or aneurysmal dilatation should be assessed on ice and fluoroscopy before accessing the asd patches in these patients to avoid embolization and complications. Pericardial patch for atrial septal defect closure sciencedirect.
Experiences in surgical closure of atrial septal defect with. Deep venous thrombosis was documented in 9 patients, and a hypercoagulable state was identified in 10. First, the surgeon makes a vertical incision in the front of the chest, opens the breastbone, and exposes the heart. Closure of an atrial septal defect with a oneway flap. Ut southwesterns cardiothoracic surgeons are experts at performing openheart surgery to correct an atrial septal defect asd, which is a hole in the hearts septum. Aorta was crossclamped but got oxygenated blood through aortic root cannula, perfused and beating. Pdf experience with autologous pericardial patch closure. Also, i would not bill separately for the asd closure since the body of the op note indicates it was closed using the same patch. Atrial septal defect asd is a common congenital cardiac anomaly. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.
Pericardial patch an overview sciencedirect topics. Some defects were closed with a patch of pericardium the normal lining outside the heart or synthetic material such as dacron. These cases span fourteen years and two hospitals, and encompass an. A deliberate bias for patch closure rather than primary suture closure is held by the surgeon author. Its a common type of heart defect, but if untreated, it can cause your childs heart and lungs to work harder. Repair of primum asd with cleft mitral valve operative. Symptoms in the first months of life should alert one to the possibility of associated leftside obstructive lesions which may complicate. Sinus venosus asds are located outside of the oval fossa at the point of entry of the svc into the right.
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