Further observations on the closure of atrial septal defects.

EXPERIMENTAL efforts to close defects of the atrial septum surgically have previously been reported.' One method studied proved entirely reliable and appeared altogether suitable for use in human subjects. It involved fixing to an incision in the atrial wall a half-moon shaped pocket made of autogenous pericardium (fig. 1). This could be invaginated into the atrial cavity and through it one could palpate without difficulty the rim of the septal defect. The defect could then be snugly closed by suturing the posterior wall of the pocket to its margins. The procedure could be applied regularly in dogs with artificially created large atrial septal defects without mortality, without interference with cardiac function, without blood loss, and without danger of air embolism or intracardiac thrombosis. The autogenous grafts all survived and became firmly united with the margins of the septum. Closure was complete in all except a few animals, and in the exceptional cases the residual defect was inconsequential, being only approximately 1 mm. in diameter. This method as finally developed was utilized in two human cases.2 In both the