title: Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency: a safe alternative to surgical repair.
abstract: OBJECTIVE
  Our objective was to evaluate the safety and feasibility of intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency.
  
  
  METHODS
  From January 2005 to December 2008, we enrolled 65 patients who had a secundum atrial septal defect with inferior vena cava rim deficiency closure in our institution. Patients were divided into 2 groups: 35 patients in group I underwent intraoperative device closure with a right lateral minithoracotomy and 30 in group II underwent open cardiac repair with a right lateral thoracotomy and cardiopulmonary bypass. Intraoperative device closure involved a minimal intercostal incision that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography and the insertion of the device through the delivery sheath to occlude the atrial septal defect.
  
  
  RESULTS
  The procedure was successful in all patients. In group I, the diameter of the atrial septal defect ranged from 30 to 44 mm (mean, 35.3 ± 3.9 mm), and the size of the implanted occluder ranged from 34 to 48 mm (mean, 40 ± 2.1 mm). The total occlusion rate was 82.9% immediately after the operation, 97.1% at 3 months, and 100% at 12 and 24 months of follow-up. In group II, all patients had successful closure. A follow-up period of 12 to 24 months was obtained in both groups. During the follow-up, there was no recurrence, thrombosis, or device failure. In our comparative studies, group II had significantly longer operative time, intensive care unit stay, and hospital stay than group I (P < .001). The cost of group I was less than that of group II (20,450.9 ± 840.8 RMB vs 25,884.9 ± 701.8; P < .001).
  
  
  CONCLUSIONS
  Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency is a safe and feasible technique. It has the advantages of cost savings, cosmetic results, and less trauma than surgical closure. Early and midterm results are encouraging.
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Hua
authors.initials: H
authors.lastname: Cao
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.forename: Dao-Zhong
authors.initials: DZ
authors.lastname: Chen
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000015:Abnormalities, Multiple; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass; D002681:China; D017046:Cost Savings; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011474:Prosthesis Design; D018570:Risk Assessment; D055989:Septal Occluder Device / Q000191:economics; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging