The use of an autologous right atrial free wall as a patch for closure of atrial septal defects.

Abstract

Various patch materials to close large atrial septal defects (ASDs) are autologous pericardium or a large of prosthetic patches which may be associated with infrequent but definite problems. We describe our experience with the use of the right atrial free wall patch over the last two decades. Between July 1998 and December 2017, 157 patients (mean age 14.7 ± 13.9 years), underwent ASD closure using the right atrial free wall patch. Associated lesions were severe mitral regurgitation (n = 24), partial anomalous pulmonary venous drainage (n = 15), ASD closure occurring after myxoma excision (n = 12) total anomalous pulmonary venous drainage (n = 2) and tricuspid regurgitation (n = 2). Surgery was uneventful in all patients. All patients underwent serial electrocardiography and echocardiography. Follow-up in 140 of 155 survivors was 103.6 ± 0.6 months. One hundred forty of one hundred fifty-five survivors are in sinus rhythm and three have persistent atrial fibrillation. Twenty-four hours of Holter monitoring (n = 19) revealed normal sinus rhythm in all but three patients, with occasional atrial ectopics in one patient; four were lost to follow-op. Electrophysiological studies in seven consenting patients, 9 to 16 months following ASD closure showed normal atrial potentials from the site of the patch. The autologous right atrial free wall is a safe patch material for ASD closure. Its advantages are that it is autologous, endothelialized, probably viable, and carries a low risk of thromboembolism. Studies with a larger number of patients with longer follow are needed to further confirm these findings.