title: Thoracoscopic ASD closure is a reliable supplement for percutaneous treatment.
abstract: OBJECTIVE
  To determine the feasibility and effectiveness of endoscopic atrial septal defect (ASD) closure when percutaneous ASD closure is impossible or has failed.
  
  
  METHODS
  Between March 1997 and February 2003, 74 patients (63% female, mean (SD) age 44 (16) years) underwent an endoscopic ASD closure. Median preoperative New York Heart Association functional class was I. Clinical and echocardiographic follow up was obtained for all patients (mean (SD) 38 (19) months). Patients were assessed for scar aesthetics, procedure related pain, functional recovery, and overall patient satisfaction.
  
  
  RESULTS
  ASD closure was successful in all patients (two primum ASD, 68 secundum ASD, four sinus venosus type). Patch repair was performed in 42%. Mean aortic cross clamp and cardiopulmonary bypass times were 54 (24) minutes and 98 (35) minutes, respectively. There were no in-hospital deaths and no conversions to sternotomy. Complications included one iliac vein stenting, one femoral arterioplasty, two revisions for suspected bleeding, and seven cases of atrial fibrillation. Two patients required late reoperation: one for atrial thrombus and another for tricuspid regurgitation. Echocardiographic control confirmed complete ASD closure in 71 patients and a small residual shunt in three patients. Ninety three per cent of the patients were highly satisfied with very low procedure related pain and 97% felt they had an aesthetically pleasing scar.
  
  
  CONCLUSIONS
  Endoscopic ASD closure can be safely done with a high degree of patient satisfaction. It is now the authors' exclusive surgical approach whenever percutaneous treatment is not indicated or has failed.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium. filip.casselman@olvz-aalst.be
authors.forename: F P
authors.initials: FP
authors.lastname: Casselman
authors.forename: H
authors.initials: H
authors.lastname: Dom
authors.forename: B
authors.initials: B
authors.lastname: De Bruyne
authors.forename: Y
authors.initials: Y
authors.lastname: Vermeulen
authors.forename: H
authors.initials: H
authors.lastname: Vanermen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002921:Cicatrix / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*