Further Observations on the Closure of Atrial Septal Defects

Though patients with small atrial septal defects may do well, in certain individuals with large defects operative closure is highly desirable because of the resultant cardiac dysfunction and the poor prognosis without treatment. Extensive efforts in the experimental laboratory have led to the development of a number of methods for the surgical closure of these defects, a number of which have had clinical trial. An earlier method, in which a pericardial pocket was affixed to an incision in the atrial wall and invaginated into the atrial cavity so that its posterior wall could be sutured to the rim of the defect, proved safe and reliable in experimental animals. One case demonstrated, however, that in large human defects the pericardium may not become sufficiently rapidly vascularized to permit its survival. The present experiments have shown that the same technic modified by substitution of a plastic nylon pocket appears entirely satisfactory. In one clinical case it was applied with success. It is suggested that when simpler methods are not applicable this procedure may prove safer and more reliable than certain other methods which have been used.