J Thorac Cardiovasc Surg 1996;111:286
© 1996 Mosby, Inc.
Valved atrial septal patch
Niv Ad, MD,
Jacob Barak, MD,
Einat Birk, MD,
Shmuel Diamant, MD,
Bernardo A. Vidne, MD
Department of Cardiothoracic Surgery
Beilinson Medical Center
Petach Tikva 49100, Israel
Reply to the Editor:
We thank Dr. Leyro-Diaz for bringing to our attention the report by Drs. Luluaga and Yosifides de Luluaga on their clinical experience. Their work, in which they used a device closely resembling ours, is very important. Such an experience with two patients with an atrial septal defect and pulmonary hypertension contributes greatly to the establishment of this surgical concept of decompressing the right ventricle through an interatrial communication to reduce the risk of postoperative right heart failure. We congratulate Drs. Luluaga and Yosifides de Luluaga for this early work. We wish their work had been published in the English medical literature, so that it would have been available to English-speaking physicians.
A prospective clinical trial comprising 15 patients has already been performed and will be published in THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. In this trial, patients for whom the one-way, valved, atrial septal patch was deemed suitable were divided into three groups: group 1 comprised patients with hypoplastic right ventricle, small tricuspid valve, and severe pulmonic stenosis or atresia; group 2 comprised patients with high pulmonary vascular resistance resulting from a large left-to-right shunt from an atrial or ventricular septal defect; and group 3 comprised patients with intraoperative acute right heart failure developing after complete repair of their congenital malformation. The right heart failure was resistant to maximal pharmacologic treatment, and the device was used as a last resort to wean the patients from cardiopulmonary bypass.
