A one-way valved atrial septal patch: a new surgical technique and its clinical application.
Patients who undergo surgical repair of congenital heart defects, characterized by a hypoplastic right ventricle or high pulmonary vascular resistance, are at high risk for the development of postoperative right heart failure. This risk may discourage the surgical team from carrying out a biventricular or complete repair in such patients. To reduce the risk for right heart failure, we developed a one-way, valved, atrial septal patch to serve as an artificial one-way foramen ovale and tested it in an animal model. By permitting right-to-left shunt, this device decompresses the failing right ventricle and maintains systemic cardiac output. The device has been used in 15 patients divided into three different groups: group 1 (n = 8), patients with a hypoplastic right ventricle and pulmonic stenosis or atresia, seven of whom underwent a biventricular repair; group 2 (n = 5), patients with evidence of pulmonary disease after longstanding left-to-right shunt caused by a correctable atrial or ventricular septal defect, all of whom had a complete repair; group 3, two patients with acute right heart failure in whom the device was used as a last option of treatment to wean them from cardiopulmonary bypass. This article presents our data in regard to the use of the one-way, valved, atrial septal patch and the indications for its clinical use.
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Department of Cardiothoracic Surgery, Tel Aviv Medical Center, Israel.
Birk
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E
Barak
J
J
Diamant
S
S
Snir
E
E
Vidne
B A
BA
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006325:Heart Atria; D006330:Heart Defects, Congenital / Q000601:surgery*; D006346:Heart Septum; D006801:Humans; D007223:Infant; D008297:Male; D019736:Prostheses and Implants; D016896:Treatment Outcome; D015300:Ventilator Weaning