Circulation, Vol 69, 905-913, Copyright © 1984 by American Heart Association
T Sondergard and PK Paulsen
The circumclusion method for surgical closure of atrial septal defects
(ASDs) of the secundum type makes it possible, during surgery, to close and
reopen the defect as desired. In each of 23 patients the following
statistically significant pressure and flow changes were found when the ASD
was closed: increasing mean pressures in the ascending aorta (from 74 to 87
mm Hg), left atrium (from 10 to 18 mm Hg), and right pulmonary artery (from
20 to 24 mm Hg); increasing mean flows in the ascending aorta (from 84 to
111 ml/min/kg); decreasing mean pressures in the right atrium (from 9.0 to
7.7 mm Hg); and decreasing mean flows in the right pulmonary artery (from
78 to 46 ml/min/kg). Surprisingly, no correlation between shunt size
determined before and during surgery was found. However, in the calculation
of the intraoperative shunt, several factors might have contributed to an
erroneous result. In 17 patients a right heart catheterization was
performed in the third to thirteenth postoperative month and the following
statistically significant changes from the intraoperative results with
closed ASD were found: The intraoperative mean pressure in the left atrium
(18 mm Hg) decreased to 7.3 mm Hg after surgery (pulmonary wedge pressure),
the pulmonary arterial pressure decreased from 23 to 13 mm Hg, and the
right atrial pressure from 8.2 to 1.6 mm Hg.
ARTICLES
Some immediate hemodynamic consequences of closure of atrial septal defects of the secundum type