Transatrial Approach for Closure of Ventricular Septal Defect

The transatrial approach for closure of isolated ventricular septal defects (VSD) has been routinely used at this clinic since 1960. Sixty-six patients with a median age of 61/2 (range 11/2 to 62 years) were operated upon with a mortality of 6% (four patients). All patients who died had associated pulmonary hypertension. Multiple defects were encountered in eight patients (12%). With the exception of two low muscular defects, all VSDs could be closed through the atrial incision. All the surviving patients were followed-up after operation and in two-thirds of them a postoperative cardiac catheterization was made. The pulmonary artery pressure decreased after surgery in all but two patients in whom the VSD was closed at the age of 4 and 9 years respectively. Residual left-to-right shunts were found in eight patients, three of whom required re-operation. None of the patients in the series had signs of tricuspid incompetence at follow-up. The transatrial approach is technically somewhat more difficult than th...