To evaluate the efficacy and safety of a new domestic dacron patch in the surgical treatment of congenital heart disease chd with infective endocarditis ie, a clinical controlled trial is conducted. Second, the two patch technique, first described in 1975,23 using a dacron patch for vsd closure and a pericardial patch for closure of the asd sandwiching the av valve between the patches. For asd closure by itself with these methods, the intracardiac portion of the surgical procedure required, on average, 22 minutes, including atriotomy, patch closure. Feb 22, 2016 atrial septal defect, or asd, is a congenital heart defect in which blood flows abnormally between the two atria of the heart. This technique can be performed without splitting the avvalve leaflet tissue. Atrial septal defect asd and ventricular septal defect. Asds can be closed surgically by simply sewing them closed or, in the case of larger asds, placing a patch of the patients own tissue or synthetic material e. A dacron graft can be used as a stent to repair an artery, blood vessel, or other hollow structure in your body such as the tube that carries. Correction of complete atrioventricular septal defects. Successful transcaihefer closure hus been possible with minimal morbidity and mortality.
The dacron patch is in situ lying underneath the av valves and virtually separating them for the left and right side. Minimally invasive atrial septal defect asd closure. Some flow is a normal condition both prebirth and immediately postbirth via the foramen ovale. Totally thoracoscopic surgical closure of atrial septal. Devices currently under investigation for asd closure include the buttoned device, cardioseal septal occluder, starflex, atrial septal defect. An atrial septal defect or asd is an opening between the upper two chambers of. Normally, the atria are separated by a wall called the interatrial. Atrial septal defect asd and ventricular septal defect vsd. The small size atrial septal defects are most commonly closed primarily with suture called as direct closure either single or double layer. 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. After cleft closure, the vent is reinserted and the atrial septal defect is close with the pericardial patch fig. The aim of this work was to study the behaviour and.
Furthermore, the curve of the patch reinforce the fragile wall of the intraventricular septum. The first transcatheter closure of an atrial septal defect asd was performed by king and mills in 1976. Many defects can be sewn closed without using a patch. Autologous pericardium and glutaraldehydepreserved bovine pericardium are the most used. Blood returns to the heart and the operation is complete at this point. The prognosis after asd closure during childhood is excellent and late complications are uncommon.
Penetration of left and right atrial wall and aortic root. From 2009 to 20 alone, 27 consecutive asd surgical closures were performed as isolated procedures meaning the asd was the major thing done with a 100 percent. The pericardial patch has been fixed in glutaraldehyde and is tailored according to the size of the asd. Augmenting the patients own pericardium to assist in closure following openheart surgery. Complications following closure of atrial septal defects. Surgical patch closure of atrial septal defects request pdf. Ventricular septal defect surgical repair pediatric heart. The idea of the pericardium eventually adhering to the dacron patch and. Background our purpose was to evaluate a new prosthesis for percutaneous closure of secundum atrial septal defects asds methods and results percutaneous closure of surgically created fossa ovalis asd was attempted in 15 minipigs. Jun 25, 2008 pericadial patch closure of asd secundum on nomothermic beating heart.
The heart is stopped and opened, and the hole is closed with a patch made of a synthetic material like dacron or a patch of pericardium the thick sac that surrounds the heart. Surgical treatment of isolated secundum atrial septal defect in. Atrial septal defect forgotten treatment guidelines longdom. Atrial septal defect asd is a congenital heart defect in which blood flows between the atria upper chambers of the heart. Closure of the atrial septal defect with a continuous suture using a dacron patch. The dor procedure is a medical technique used as part of heart surgery and originally introduced by the french cardiac surgeon vincent dor b.
Transcatheter approaches of atrial septal defect closure are well accepted. This patch is also ushaped with a straight cut to fit the free edge of the dacron patch at the av valve level. The dor procedure uses a circular suture and a dacron patch to correct lv aneurysms and exclude scarred parts of the septum and ventricular wall and would prove to be the best option amongst the other methods of ventricular remodeling, i. Even if you are having no symptoms, closing an asd early in life may prevent heart problems in later life. Totally thoracoscopic surgical closure of atrial septal defect in. It is common in patients with a congenital atrial septal.
For the next two decades, the twopatch technique was the accepted gold standard. Lyophilized bovine pericardium has not been tested inside the cardiovascular system. Transvenous closure of secundum atrial septal defects. Closing holes in the heart repairing hole in heart daic. In conclusion, the new lyophilized bioprosthesis is well integrated into the atrial septum, without complications and is effective for asd closure. Devices currently under investigation for asd closure include the buttoned device, cardioseal septal occluder, starflex, atrial septal defect occluding system asdos, guardian angel, and the helex. Efficacy and safety of dacron patch in surgical treatment.
Your doctors asd repair plan may depend upon the type of asd you have. Closure of an atrial septal defect with a oneway flap patch in a. Correction of complete atrioventricular septal defects with. Second, the twopatch technique, first described in 1975,23 using a dacron patch for vsd closure and a pericardial patch for closure of the asd sandwiching the av valve between the patches. Closure of an atrial septal defect with a oneway flap patch. Mar 31, 2014 infants with unrestrictive ventricular septal defects vsds who 1 have congestive heart failure chf that is refractory to medical management and 2 are not growing should undergo surgery to close the defect, regardless of the patients age or size. Nov 14, 2016 the single dacron patch placed on the left side of the intraventricular septum, which covers the anterior vsd and ventriculotomy from the inside in a double layer, sticks to the endocardium tightly due to the high blood pressure of the left ventricle. Surgical patch closure of atrial septal defects the. The size of the ventricular patch used with the twopatch technique became smaller with time. The uvp was constructed from a dacron patch approximately as large as the size of the defect to be closed.
Jul 20, 2010 watch the video transcatheter closure of holes in the heart. Edwards lifesciences, the longestablished bovine tissue technology leader, provides the edwards bovine pericardial patch designed for a variety of applications including. Anesthetic management of amplatzer atrial septal defect. However, when it is not treated with glutaraldehyde, it is dif. Aorta was crossclamped but got oxygenated blood through aortic root cannula, perfused and beating. Transseptal access in these patients is perceived to be difficult.
The patient was weaned from cpb with infusion of nitroglycerine 1. Once the patch is sutured into place, the heart is closed and the patient is removed from cardiopulmonary bypass. Patients with atrial septal defect asd are at higher risk for atrial fibrillation af even after repair. Some defects were closed with a patch of pericardium the normal lining outside the heart or synthetic material such as dacron. Complications are minimal and the length of stay in the hospital is about three days. Cooleys linear suturing and jatenes circular external suturing. Unidirectional valved patches for closure of septal defects.
If an asd is repaired early enough, you may not need any more surgeries for the asd. The surgical treatment for asds and vsds is openheart surgery. From march 2009 to october 2010, 28 patients, with a mean age of 5. Hybrid techniques, such as surgical repair of coarctation of the aorta and simultaneous use of a device to close an asd, were suggested by mills and king in 1976. The paired opposing umbrellas were covered with dacron, the umbrella had to. In 1985, dor introduced evcpp as a viable method for restoring a dilated left ventricle lv to its normal, elliptical geometry. All the patients underwent pvai through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography ice. Atrial septal defect asd is a common congenital cardiac anomaly. Atrial septal defect asd repair, heart and vascular care. In the inferior region, careful placement of the stitches on the left side of the asd is necessary to avoid any damage to the conduction system.
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. Ventricular septal defect surgical repair pediatric. Closing a large asd by openheart surgery usually is done in early childhood, even in. The pericardium would eventually adhere to the dacron patch producing a secure closure of the septal defect. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. Some asd closure devices have been modified a number of times to improve technical feasibility, safety, and effectiveness.
Group ii showed encapsulated dacron patch covered with collagenous tissue and cartilaginous metaplasia. Complications in atrial septal defect device closure. A piece of quadrangular pericardium was attached by suture to the surface of the dacron patch. Abnormal opening between the left and right ventricles. However, many defects that required surgery may have been sewn closed without using a patch. Atrial septal defect asd american heart association. Asdpatent foramen ovale pfo repair patients group i, n 45 with age. Smaller asds can simply be closed using a suture and oversewing the hole. It also may depend on where the asd is in the heart wall. Closure of an atrial septal defect with a oneway flap. Pfo as such or to make an artificial asd to reduce.
Ptfe is a fluoride resin composed of only carbon and fluoride. At rady childrens hospitalsan diego, patients have been undergoing successful asd closure surgery for more than 30 years using a standard, timehonored approach of patch closure. A variety of patch materials has been used to close large atrial septal defects asd. Unidirectional valved patches for closure of septal. Balloon mitral valvuloplasty by antegrade technique in a postoperative patient who underwent dacron patch closure of asd article in indian heart journal 581. Transcatheter closure of septal defects medical clinical. A dacron graft is made out of a manmade synthetic polyester material. In vivo biocompatibility, biological biomaterials, scaffolds, cardiovascular tissue. Most dacron grafts are in the shape of a tube to replace or repair blood vessels. Billing open septal defect repair codes with 9358093581. Some difficulty was experienced in placing this patch accurately because the inferior pulmonary vein lay close to the line of closure of the septum.
For larger asds, a patch is usually used to close the hole. Lyophilized glutaraldehydepreserved bovine pericardium for. This patch can be taken from the pericardium the sac that surrounds the heart or from synthetic materials such as dacron or teflon. Atrial septal defect forgotten treatment guidelines. The device was retrieved followed by dacron patch closure of asd and tricuspid valve repair. It is also known as endoventricular circular patch plasty evcpp. Citeseerx document details isaac councill, lee giles, pradeep teregowda.
Balloon mitral valvuloplasty by antegrade technique in a. Efficacy and safety of dacron patch in surgical treatment of. Post mi vsd intracardiac double patch repair ctsnet. Surgical repair of atrial septal defect in patients over. Pericadial patch closure of asd secundum on nomothermic beating heart. Closure of an atrial septal defect with a oneway flap patch in. For larger size atrial septal defect use of glutaraldehyde treated autologous pericardial patch or double velour dacron patch is advocated. Surgical patch closure o larger asds o sinus venosus asd o patch material.
Fortunately over time the natural tissue of the heart grows over the vsd patch and seals it into place. Patients are supported by a heartlung machine intraoperatively and the asd is approached through an opening in the right atrium figure 1 open asd. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation pvai in these patients. Closure of an atrial septal defect with a oneway flap patch in a patient with severe pulmonary hypertension. Asd repairs require the use of cardiopulmonary bypass, otherwise known as the heartlung machine. Ventricular septal defect surgery in the pediatric patient. A history of asd closure cardiac interventions today. The most commonly used prosthetic patching materials are expanded polytetrafluoroethylene ptfe and dacron.