A one-way, valved, atrial septal patch in the management of postoperative right heart failure. An animal study

Patients who undergo surgical repair of congenital heart defects that are characterized by hypoplastic right ventricle or pulmonary hypertension are at high risk for the development of postoperative right heart failure. To minimize this risk, a new one-way, valved, atrial septal patch was developed that serves as an artificial one-way foramen ovale. The feasibility of this device was tested in five dogs in which reversible right heart failure had been induced. Use of the one-way valved patch significantly improved right ventricular performance and reduced right ventricular hydrostatic pressures. The interatrial pressure gradient was reduced from 10 +/- 3.5 mm Hg during right heart failure to 4.4 +/- 1.4 mm Hg. When the device was opened, cardiac output increased significantly. This hemodynamic improvement was achieved at the expense of systemic arterial desaturation, which was, however, well tolerated. When the state of right heart failure was reversed, the one-way valved patch spontaneously closed, allowing no interarterial shunting. The results of this experimental trial suggest that this device can play a useful role in selected patients in whom postoperative right heart failure can be anticipated after surgical repair of certain congenital heart defects.