Autologous Right Atrial Wall Patch for Closure of Atrial Septal Defects

Abstract

We used the right atrial free wall as a patch to close atrial septal defects (ASD) and report its results. Between July 1998 and April 2006, 87 patients (mean age, 21.9 +/- 13.9 years; range, 7 months to 54 years), underwent closure of ASD with an autologous right atrial free wall patch. The underlying diagnosis were very large secundum ASD in 51 patients, sinus venosus defect in 15, primum ASD in 5, large defect resulting from excision of a left atrial myxoma in 12, complete atrioventricular canal defect in 1, total anomalous pulmonary venous return with ASD in 2, and Ebstein anomaly with a large ASD in 1. Associated surgical procedures were mitral valve repair in 18 patients, repair of total or partial anomalous pulmonary venous drainage in 17, mitral valve replacement in 1, and tricuspid valve repair for Ebstein anomaly in 1. There were two early deaths. One patient with primum defect and preoperative congestive heart failure died 3 weeks postoperatively from refractory ventricular fibrillation. Another patient died from persistent congestive heart failure after undergoing reoperation for residual mitral regurgitation. The remaining patients were discharged after 4 to 9 days. No flow was detected across the septal patch on predischarge echocardiography. At a mean follow up of 53.4 +/- 26.7 months (range, 1 to 103 months), all patients except 1 are in sinus rhythm. One patient underwent reoperation for failed mitral valve repair after 1 month. At reoperation, the patch was intact with normal texture and without any suture dehiscence. Histopathologic examination of the explanted patch revealed viable endothelium and subendothelial muscle on both the surfaces of the patch. Results of Holter monitoring in 9 patients were normal. Electrophysiologic studies in 2 patients recorded normal atrial potentials from the site of the patch. No patch shrinkage, calcification, or thromboembolic complications were noted. The autologous, free, right atrial wall can be safely used as a patch for ASD closure and offers several advantages.