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| Anatomical location of ASD |
Indication for Surgery
The presence of an ASD or PAPVC (Partial Anomalous Pulmonary Venous Connection) with light ventricular volume overload and a significant left light shunt (Qp/Qs Of < 1.5: 1) is an indication for closure. The optimal age for operation is usually 1 to 2 years. Surgery can be done at very young and very old age. Pulmonary vascular disease which raises pulmonary vascular resistance to >8 units / m'at rest makes an ASD inoperable. Associated mitral and tricuspid regurgitations are not contra indications for surgely and they might need valve repair.
Generally a very small defect that is less than 5 mm in diameter does not require surgery. However, there is a possibility of paradoxical embolism even in such small defects. If the patient has a history of stroke, closure is advised. Surgical closure is indicated in such cases if device closure is contra indicated or it has failed.
Types of Surgery
Technique of operatio11 depends on the moi-pholagy of the atrial septal defect
Fossn Ovnlis Defect (Ostiurtt Secundzim Defict)
This is the most common type of atrial septal defect.The lrsual approach is through a midline incision and median sternotomy. In
young girls, for cosmetic reason, approach through a subinamlnary light thoracotorny or low and nlinimally invasive nlidline incision is used. Piece or pericardium is harvested for patch closure of the defect. Ascending aortic and bicaval can~lulations are done Sor cardio pulmonary bypass. The operation is done at 32 to 34°C after aorta is clanpcd a~id aortic root cardioplegia given.
Operation for Patients with High Pulmonary Vascular Resistance
When the pulmonary vascular resistance is very high (6-8 units/m 2 ) closure of ASD is done either with fenestrated patch or flap valve patch pushed under limbus fossa ovalis.In the flap valve technique if RA pressure goes very high it allows right to left shunt. If left atrial pressure is higher the flap valve closes against limbus fossa aovalis, which does not allow left to right shunt.
The presence of an ASD or PAPVC (Partial Anomalous Pulmonary Venous Connection) with light ventricular volume overload and a significant left light shunt (Qp/Qs Of < 1.5: 1) is an indication for closure. The optimal age for operation is usually 1 to 2 years. Surgery can be done at very young and very old age. Pulmonary vascular disease which raises pulmonary vascular resistance to >8 units / m'at rest makes an ASD inoperable. Associated mitral and tricuspid regurgitations are not contra indications for surgely and they might need valve repair.
Generally a very small defect that is less than 5 mm in diameter does not require surgery. However, there is a possibility of paradoxical embolism even in such small defects. If the patient has a history of stroke, closure is advised. Surgical closure is indicated in such cases if device closure is contra indicated or it has failed.
Types of Surgery
Technique of operatio11 depends on the moi-pholagy of the atrial septal defect
Fossn Ovnlis Defect (Ostiurtt Secundzim Defict)
This is the most common type of atrial septal defect.The lrsual approach is through a midline incision and median sternotomy. In
young girls, for cosmetic reason, approach through a subinamlnary light thoracotorny or low and nlinimally invasive nlidline incision is used. Piece or pericardium is harvested for patch closure of the defect. Ascending aortic and bicaval can~lulations are done Sor cardio pulmonary bypass. The operation is done at 32 to 34°C after aorta is clanpcd a~id aortic root cardioplegia given.
Operation for Patients with High Pulmonary Vascular Resistance
When the pulmonary vascular resistance is very high (6-8 units/m 2 ) closure of ASD is done either with fenestrated patch or flap valve patch pushed under limbus fossa ovalis.In the flap valve technique if RA pressure goes very high it allows right to left shunt. If left atrial pressure is higher the flap valve closes against limbus fossa aovalis, which does not allow left to right shunt.
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