The Results of Surgical Repair of Atrial Septal Defect

ALTHOUGH atrial septal defect is onle of the commllonlest of the congenital heart lesions, and the anatomical features have been recognised since the early nineteenth century, it is only in the last thirty years that a clearly defined clinical picture has emerged (Roesler, 1934; Bedford Papp and Parkinson, 1941). Precision in diagnosis came with the use of cardiac catheterization (Wood, 1950; Dexter, 1956). With advanice in diagniosis, methods of surgical correction wvere sought, and various "closed" operations-either distortioni byexternal sutures or suturing of the free atrial wall to the edges of the defect-were proposed and achieved some popularity (Bailey et al., 1953). Gross (1952) repaired the defect at the bottomii of an atrial well filled with blood, aned this method is still in use. It became clear, however, that a nmethod in which the defect could be seen and repaired under direct visioni was itnfinitely preferable, and following the introduction of hypothermia-a procedure allowving circulatory arrest of up to teni minutes-Lewis and Taufic (1953) reported the first successful closure of an atrial septal defect under direct vision. Subsequently this method passed into general use and reports from various cenitres have described the results and discussed the problems of the procedure (Swan et al., 1953; Blount et al., 1956). Amonig the 383 cases of congenital heart disease from the Cardiac Clinics of the Royal Belfast Hospital for Sick Children anid the Royal Victoria Hospital, Belfast, which have been investigated in the Cardiac Catheterization Unit in the Roval Victoria Hospital there have been one hundred cases of atrial septal defect. Of these, forty have been submitted to operation. This paper describes the clinical feattures, the findings on investigationi, the findinigs at operatioll, the complications, anid the post-operative assessment of these forty cases. There were three operative deaths anid one post-operative death in the series.