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J Thorac Cardiovasc Surg 2003;125:S85-S86
© 2003 The American Association for Thoracic Surgery

Editorials

Transcatheter closure of atrial septal defects

From the Division of Thoracic Surgery, Department of Surgery, University of Louisville, and Kosair Children's Hospital, Louisville, Ky.

Received for publication Sept 21, 2000. Accepted for publication Oct 11, 2000. Address for reprints: Erle H. Austin, MD, 201 Abraham Flexner Way, #1200, Louisville, KY 40202.

The first 20% of the full text of this article appears below.

The era of open heart surgery began with a variety of ingenious techniques directed at closure of the secundum atrial septal defect (ASD). ^1-4 Indeed, the first successful application of cardiopulmonary bypass was for this purpose. ⁵ Direct vision intracardiac surgery owes its origins to the ASD. Over the past half century surgical closure of a secundum ASD has become a low-risk and highly successful procedure. ^6,7 In addition to being bread and butter for the heart surgeon, ASD closure has become a valuable procedure for introducing the cardiothoracic resident to true "open" heart surgery. Until recently, cardiovascular surgeons have felt privileged and (maybe, self-importantly) exclusively qualified to close these defects. Now our turf is being challenged once again by some bright and innovative nonsurgeons, the interventional cardiologists. Our cardiology colleagues, demonstrating ingenuity not unlike that of our predecessors in cardiac surgery, have developed techniques to close interatrial communications with a catheter! Is transcatheter ASD closure a safe and reasonable approach? Is it a threat to our livelihood or our ability to train residents? What role should we play in its introduction?

The first successful transcatheter closure of an ASD occurred a quarter of a century ago. Thus, it is somewhat surprising that the technique is only now becoming an alternative to surgery. The initial report in 1976 by King and Mills ⁸ demonstrated the feasibility of the approach, but the requirement for a very large (23F) delivery catheter . . . [Full Text of this Article]