Transatrial Approach for Closure of Ventricular Septal Defect

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Abstract
The transatrial approach for closure of isolated ventricular septal defects (VSD) has been routinely used at this clinic since 1960. Sixty-six patients with a median age of 61/2 (range 11/2 to 62 years) were operated upon with a mortality of 6% (four patients). All patients who died had associated pulmonary hypertension. Multiple defects were encountered in eight patients (12%). With the exception of two low muscular defects, all VSDs could be closed through the atrial incision. All the surviving patients were followed-up after operation and in two-thirds of them a postoperative cardiac catheterization was made. The pulmonary artery pressure decreased after surgery in all but two patients in whom the VSD was closed at the age of 4 and 9 years respectively. Residual left-to-right shunts were found in eight patients, three of whom required re-operation. None of the patients in the series had signs of tricuspid incompetence at follow-up. The transatrial approach is technically somewhat more difficult than the transventricular, but with a completely relaxed heart, utilizing aortic occlusion and local hypothermia, it is usually possible to close the defect without detaching the tricuspid valve. The principle advantage of the transatrial approach is the avoidance of a right ventricular incision. This is of particular importance in patients with associated pulmonary vascular obstruction, in whom an incision in the strained right ventricle might precipitate cardiac failure after operation.