Atrial Septal Defect: An Evaluation of Surgical Closure

¹ Department of Pediatrics, University of Minnesota Medical School.

Within the past five years, four techniques of successful surgical correction of defects in the atrial septum have been introduced and employed in significant numbers of cases. These include atrio-septo-pexy, circumclusion, closure through an atrial well, and direct vision correction in the "open" heart.

A survey of the literature for the three year period 1954 through 1956 disclosed 444 cases of atrial septal defect submitted to surgery and evaluated on a clinical or physiologic basis post-operatively 281 cases were of the ostium secundum type, 73 cases were of the persistent atrioventricularis communis variety (partial or complete forms), and 90 cases were undifferentiated as to type of defect in the published reports.

Techniques for surgical closure are described and results as reported in the literature are evaluated. All methods of closure of the ostium secundum defects have met with success; the overall mortality in the 281 cases evaluated was 8.2 per cent. Direct vision procedures employing hypothermia or a pump-oxygenator to permit stasis of the circulation to and from the heart and thus allow visualization of the defect have yielded the highest percentage of complete closures but are presently associated with the highest mortality rate among the four evaluated techniques. The complex nature of persistent atrio-ventricularis communis deformities requires long periods of work in the "open" heart, necessitating use of a pump-oxygenator for cardiopulmonary bypass. Results in the first 20 cases are equivocal; there were nine deaths, but the remaining 11 patients all demonstrate complete correction of the deformity.