title: Intraoperative device closure of large secundum atrial septal defects; a safe alternative to transcatheter closure.
abstract: OBJECTIVE
  The aim of this study is to report our short and mid-term results of intraoperative device closure (IODC) in large secundum atrial septal defects (ASD), to evaluate its safety and to determine the impact of 'short' rim on the results.
  
  
  METHODS
  Sixty-eight patients with an ASD underwent IODC through a right minithoracotomy. Patients were divided into two groups: 37 patients in group I with one short rim (< or =5 mm) and 31 in group II with sufficient rims. A 2.5-3 cm parasternal incision was made in the right third or fourth intercostal space. 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 ASD into the left atrium and the device was deployed in place.
  
  
  RESULTS
  The procedure was successful in all patients. The maximum diameter of the ASD ranged from 20 to 37 mm (mean 25+/-5 mm). There were 16 patients with the diameter of ASD more than 30 mm. The mean size of implanted devices was 29+/-4mm. Redeployment with larger device occurred in seven patients in group I and three in group II (p>0.05). Intracardiac manipulation time was 22+/-10 min in group I and 16+/-11 min in group II (p<0.01). The total occlusion rate was 84% immediately after operation, 97% at 3 months, 98% at 1 year, and 100% at 2-, 3-, 4-year follow-up. There were no other late complications during the follow-up period of 3-63 months (mean 27+/-18 months).
  
  
  CONCLUSIONS
  IODC is a safe and feasible technique in closing large ASDs. It has the advantages of cost savings, cosmetic results, and less trauma. Early and mid-term results are encouraging. In patients with ASD of a short rim, a larger device is recommended which does not influence the success rate of IODC.
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan 250021, China.
authors.forename: Li
authors.initials: L
authors.lastname: Hongxin
authors.forename: Sheng
authors.initials: S
authors.lastname: Lijun
authors.forename: Zheng-jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Zi
authors.forename: Wen-long
authors.initials: WL
authors.lastname: Zhang
authors.forename: Hai-zhou
authors.initials: HZ
authors.lastname: Zhang
authors.forename: Guo
authors.initials: G
authors.lastname: Wenbin
authors.forename: Cheng-wei
authors.initials: CW
authors.lastname: Zou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019736:Prostheses and Implants / Q000009:adverse effects; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional