Surgical device closure a new technique of ASD closure

Abstract

Conventional approach of atrial septal defect (ASD) closure with cardio pulmonary bypass using mid sternotomy, minimally invasive or endoscopic technique is time tested. We decided to use custom made device with direct minimally invasive approach without cardio pulmonary bypass. Percutaneous transfemoral route using custom made device is a well established procedure performed by interventional cardiologist with occasional trauma and vessels. We performed the procedure in 3 patients of secundum ASD deemed adequate for device closure. We used a mini Right anterior thoracotomy approach using a double umbrella device which was implanted through direct Right Atrial puncture. In two patients we were successful in deploying the device. The proedure lasted 30 minutes with small infra Mammary scar and the post operative period was uneventful. In the third case where our attempt at surgical device closure failed the inferior margin was only one mm. The optimal size device kept slipping into the right atrium when the guide-wire was tugged after final deployment. The placement of an oversize device distorted the mitral valve, may causing regurgitation. We think that this is a simple and safe technique of secundum ASD closure without cardio pulmonary bypass.