Intraoperative device closure of secundum atrial septal defect with a right anterior minithoracotomy in 100 patients

This study aims to report our experience using intraoperative device closure of secundum atrial septal defects and to evaluate the feasibility and clinical outcome of this technique.

One hundred patients with secundum atrial septal defects (mean age, 29 +/- 16 years; age range, 5-71 years; mean weight, 54 +/- 18 kg; weight range, 16-94 kg) underwent intraoperative device closure through a right minithoracotomy without cardiopulmonary bypass and fluoroscopy. A 2.5- to 3-cm parasternal or submammary incision was made in the right third or fourth intercostal space. Exposed with a miniretractor, a specially designed plastic sheath loaded with the device was inserted through the purse-string sutures placed on the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the atrial septal defect into the left atrium, and the device was deployed in place.

The procedure was successful in all patients, including 5 patients with double atrial septal defects. The maximum diameter of the atrial septal defect ranged from 5 to 37 mm (mean, 21 +/- 7 mm). There were 61 patients with an atrial septal defect diameter of more than 20 mm, 16 of them with a diameter of more than 30 mm. The mean size of implanted devices was 25 +/- 7 mm (range, 8-36 mm). Residual shunts were found in 9 (9%) patients immediately after the operation. The complete occlusion rate was 95% at discharge, 99% at the 3-month follow-up, and 100% at the 1-year follow-up. There were no other late complications during the follow-up period.

Intraoperative device closure is a safe, cost-effective, cosmetic, and less-invasive operation of most secundum atrial septal defects. Follow-up results are encouraging. It can be considered an acceptable alternative to transcatheter closure or surgical repair.