Atrial septal defect: an evaluation of surgical closure.

Successful surgical closure of an atrial septal defect was first performed by Bailey1 in January, 1952, employing the method he terms atrio-septopexy. Cohn2 in 1947 had reported results of the first experimental dosure of defects in the atrial septum, and only a year later Murray3 reported the first attempt at repair in a 12-year-old child by approximating the anterior and posterior atrial walls in the region of the septum. While early-post-operative evaluation of this case was optimistic, cardiac catheterization 14 months post-operatively by Keith and Forsyth4 demonstrated a substantial left-to-right shunt and significant pulmonary hypertension with one episode of cardiac failure during this period. Within two years of Bailey’s first successful closure by atrio’-septo-pexy, three other techniques of successful surgical correction of this relatively common congenital cardiac defect were reported in the literature. Sondergaard5 in Denmark and Bjork and Crafoord6 in Sweden introduced the method of circumclusion. Gross7 applied a prosthesis of rubber or woven nylon to the right atrium and closed the defect through this “atrial well.” Lewis8 and Swan9, employing hypothermia, were the first to work in an open heart under direct vision, although later LilleheP#{176}’ 11 and Cooley and Kirklin12 initiated the use of an extracorporeal circulation. To evaluate the results of surgical closure of the various types of atrial septal defect by the several techniques listed above and to attempt to define present indications and contraindications for closure are the purposes of this communication.