Shegu, G (2013) Surgical closure of Atrial Septal Defect (ASD): A comparative study of direct suture closure and pericardial patch closure technique. Masters thesis, Madras Medical College, Chennai.
|
Text
180100113shegu.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION : Atrial septal defect (ASD) accounts for one third of congenital heart disease in adults. 90% of the ASDs are fossa ovalis defect. Natural History is death by fourth or fifth decade when not repaired and when repaired at an earlier stage the survival approaches the rate for that of the normal population. Surgical closure of the ASD has a low morbidity and mortality. Surgical closure is usually accomplished by two methods, direct suture closure and pericardial patch closure. Cardiac surgeons preference to choose either of these two techniques to close the ASDs are very much variable. Small to moderate sized ASD were closed using direct suture technique and large ASDs were closed using pericardial patch technique. AIM OF THE STUDY : To compare the outcomes following direct suture and pericardial patch closure in Atrial septal defect OBJECTIVE OF THE STUDY : 1.To compare the mortality and morbidity. 2. To identify associated anomalies in both groups. 3. To compare the effect of these techniques in those patients with Mitral valve prolapse (MVP) and Mitral regurgitation (MR) and Tricuspid regurgitation (TR). 4. To compare the effects of these techniques in right ventricle and left ventricle chamber geometry. 5. To compare the complications (Residual shunt and Thromboembolism). 6. To compare the effectiveness of the symptom relief. 7. To compare the duration of cardio pulmonary bypass time and surgery between the two groups. 8. To compare the differences in duration of ventilator time and Hospital stay. 9. To compare the amount of blood transfusion needed in the two groups MATERIALS AND METHODS : Study design - Retrospective study. Methodology - Subject Selection: 100 patients. Inclusion Criteria: All patients with Atrial septal defect of ostium secundum type between 12 to 60 years of age with a significant left to right shunt with Qp /Qs of 1.5: 1 or greater and patients with ASD OS with symptoms. Exclusion Criteria: ASD Ostium Secundum (OS) type associated with complex congenital malformations, ASD OS with severe Mitral or Tricuspid regurgitation, angiographically confirmed acquired coronary artery disease, ASD associated with Partially Anomalous Pulmonary Venous Connections (PAPVC). Analysis Plan: Comparison of outcomes of both the surgical techniques- duration of the surgery, cardio pulmonary by pass time , changes in chamber geometry, aortic cross clamp time, need for blood products, thromboembolism, infections, other complications, duration of hospital stay and relief from symptoms. Screening Procedures / Visits: Postoperative Transthoracic echocardiography. Follow up Procedures / Visits: Transthoracic Echocardiography. Assessments of Parameters: ECG- Reduction in QRS duration. ECHO- Left ventricle internal diastolic dimension (LVID), Right ventrical internal diastolic dimension (RVID), Mitral regurgitation (MR), shunt fraction, residual shunt. In this study transthoracic ECHO was done in all patients preoperatively, postoperatively and on follow up. It was a comprehensive study that included M mode, two dimensional ECHO, continuous wave, pulsed wave and colour Doppler. In the apical four chamber view, the transverse diameter measured was taken as the right ventricle size. The tricuspid regurgitant jet velocity was used to calculate pulmonary artery pressure. The shunt ratio was measured by taking into account the velocity time integral (VTI) and the cross sectional area at the corresponding sites in the left ventricular outflow tract and the pulmonary artery. MVP was diagnosed when there was a sudden mid to late systolic posterior displacement of a part of the mitral valve to atleast 2mm below the line that joins the point of closure of the mitral valve in systole to the point of opening of the mitral valve in diastole, with leaflet displacement superiorly, confirmed by cross sectional ECHO. MVP was also diagnosed when there was pan systolic prolapse with displacement 3mm below the line joining the closure and opening of the mitral valve, with the peak in the mid systole confirmed by bulging of the mitral annulus during systole on ECHO. RESULTS : In the study of 100 patients, 54 patients presented with symptoms while the remaining had no symptoms. Patients presented with symptoms like breathlessness on exertion, palpitations, fainting attacks, tiredness, recurrent respiratory tract infections and atypical chest pain. The mean age of patients in the pericardial patch closure group was 38 ± 6 years and in that of the direct closure group mean age was 41 ± 7 years (Table 1).In the first group 62% were females and in the second group 50% were females. 27 % of patients in the first group and 30% in the second group were in NYHA class II-III respectively. Atrial fibrillation was present in 24 of the 100 patients at the time of diagnosis. 65% of the patients were females with the median age of 26 years and 35% were males with the median age of 33 years. CONCLUSION : Cardiac surgeons vary in their frequency with which they select the pericardial patch technique or direct suture closure. A patch can be used when the defect is significantly larger or when the tissues are friable and there appears to be no significant difference in the results, early and late thromboembolic complications. When circumstances are ideal the ease and simplicity of direct closure supports its use in many patients.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | Reg.No.18101003 |
| Uncontrolled Keywords: | Surgical closure of Atrial Septal Defect ; comparative study ; direct suture closure ; pericardial patch closure technique. |
| Subjects: | MEDICAL > Cardio Vascular and Thoracic Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 10 Nov 2017 18:13 |
| Last Modified: | 24 Aug 2020 04:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3889 |
Actions (login required)
 |
View Item |
