Darçin Osman Tansel, Kunt Alper Sami, Andac Mehmet Halit
Department of Cardiovascular Surgery, Harran University, Faculty of Medicine, Sanliurfa, Turkey.
Heart Surg Forum. 2005;8(2):E96-7. doi: 10.1532/HSF98.20041173.
Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure.
In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion.
During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery.
Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.
尽管各种合成材料和心包已用于房间隔缺损（ASD）封堵，但研究人员仍在继续寻找用于该手术的理想材料。我们报告并评估了一例使用自体右心房壁组织进行ASD封堵的病例。
在此病例中，我们为一名22岁女性封堵继发孔型ASD，该患者因缺损还伴有右心房扩大。在建立标准双腔插管和全心肺转流后，我们在右心房上方做一个斜切口，位置高于标准切口。检查继发孔型ASD后，我们在心房壁下缘制作了一个瓣片。在瓣片尖端与缺损上缘之间缝合一根牵引缝线，此后沿顺时针方向继续缝合。考虑到缺损的大小和形状，我们切开瓣片的下缘附着处，完成缝合。切除下缘瓣片的残余部分，以类似方式关闭右心房。
超声心动图检查显示，房间隔未见残余分流或移植物周围血栓形成。患者完全康复出院。
自体右心房补片是ASD封堵的理想材料，尤其是对于右心房较大的患者。由于右心房组织的肌肉性质及其厚度，能实现完全贴合，与其他材料相比，它与房间隔更匹配。
