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Ann Thorac Surg 2007;83:1580
© 2007 The Society of Thoracic Surgeons

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Correspondence

Problems in Per-Operative Secundum Atrial Septal Defect Device Closure: Our Experience

Department of Cardiovascular & Thoracic Surgery, J.N. Medical College & KLES Hospital & MRC, Belgaum, Karnataka 590010, India

(Email: drmddixit{at}yahoo.com; dr_adayal{at}yahoo.com).

To the Editor:

We read with interest the article by Liang and colleagues [1] regarding surgical closure of the secundum atrial septal defect (ASD) with a device. The technique used by the authors is to be commended for its simplicity. We have used this technique in 3 patients ourselves, and we were able to successful close the defect in 2 patients. However we wish to raise a few issues.

1 No mention is made about the criterion used to select patients to undergo this procedure. Why were these patients not selected to undergo transfemoral device closure?

2 The authors conclude by saying that this procedure is cosmetically superior to conventional surgery. One would think that in today’s era a more valid comparison would be with transfemoral device closure, in which case, even the 3-cm scar is inferior to the groin puncture mark of a transfemoral device closure.

3 In view of their extensive experience with this technique, one expects the authors to discuss the merits and demerits of this procedure and its current standing among the techniques available for the closure of an uncomplicated secundum ASD. Among the patients with an ASD, who should be primarily considered for this procedure?

4 Table 1 in the article mentions that in 26 of the 53 patients, one margin of the ASD was deficient (near aortic sinus, 20; near inferior vena cava, 5; and near superior vena cava, 1). Despite this, the authors have been able to perform device closure in all their patients. It stands to reason that one of the prerequisites of successful device closure is that there should be a good margin all around to anchor the device. If any of the margins is absent, the patient is considered a surgical candidate.

In fact in the 1 case of 3 in which our attempt at surgical device closure failed, the inferior margin at the base of the IVC was absent. The optimal size device kept slipping into the right atrium when the guidewire was tugged after final deployment. Deployment of an oversized device ameliorated this problem but caused unacceptable mitral regurgitation. The thoracotomy was then extended and the ASD was closed under cardiopulmonary bypass. The previously described findings were again confirmed after right atriotomy under cardiopulmonary bypass. The device was tried with the right atrium open and it failed to occlude. Did the authors ever face this problem and how were they able to seat a device when the when the margins were deficient without placing an "oversized device," or producing mitral regurgitation, or interfering with movement of the mitral valve cusp as seen on echocardiography?

We hope that the authors can provide a satisfactory response to our questions.

	References

Top References

 

1. Liang T, XiangJun Z, XiaoJing M, Yun L, Leng CY. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients Ann Thor Surg 2006;81:1417-1419.[Abstract/Free Full Text]

This article has been cited by other articles:

				L. Tao, X. J. Zeng, X. J. Ma, Y. H. Luo, Y. P. Lim, and Y. L. Chua The Experience of Occluding Secundum Atrial Septal Defect Ann. Thorac. Surg., February 1, 2008; 85(2): 695 - 695. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kizakke K. Pradeep Mohan Gan Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dixit, M. D. Articles by Dayal, A. Search for Related Content PubMed PubMed Citation Articles by Dixit, M. D. Articles by Dayal, A. Related Collections Congenital - acyanotic