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J Thorac Cardiovasc Surg 1996;111:841-848
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

A ONE-WAY VALVED ATRIAL SEPTAL PATCH: A NEW SURGICAL TECHNIQUE AND ITS CLINICAL APPLICATION

Received for publication Feb. 1, 1995 Accepted for publication May 18, 1995. Address for reprints: B. A. Vidne, MD, Head, Department of Cardiothoracic Surgery, Beilinson Medical Center, Petach Tikva 49100, Israel.

Abstract

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. (J THORACCARDIOVASCSURG1996;111:841-8)

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