[HSF] ASD patch

[Mehta Sukumar]

Ajit,
  My experience - 
  Goretex and bovine pericardium, never. Because of the cost.
   
  Double velour Dacron - In my early years of training and practice, from 1985 to 1990. Excellent handling property, good endothelialisation over the time and small but definite chance of haemolysis if there is a jet of mitral regurgitation. But not seen any significant hemolysis in my practice. 
  Probably, another advantage is, Dacron does not shrink like autogenous pericardial patch does, sometimes. I don't use it now as it involves a small incremental cost.
   
  For last more than a decade now, my only choice has been fresh autogenous pericardium, un-treated with any chemical. I suture it so as to avoid any tension in any axis. In fact leave a little, comfortable redundancy. I use continuous suture of 4-0 Prolene, with sufficiently deep bites of the margin, where there is a rim. Where there is no rim, I take sufficiently thick bites of left atrial endocardium and myocardium. Occasionally, I do re-inforce with 2 or 3 or 4 interrupted sutures. For the superior rim, in your case, your bites may be more easily placed in the right atrial wall and not on the left atrial side. If the defect extends almost upto the IVC-RA junction, the inferior margin is often missing or flimsy and it's better to pass stitches through a thickness of the LA there.
  Sukumar. 

Ajit Damle <damle at cableone.net> wrote:
  I would like recommendations for closure of a large secundum ASD in a 35 yr
healthy female. PCI is not possible the defect is very high, near the sinus
of valsava and does not have enough superior rim.

What is your experience with autologus pericardium, bovine pericardium and
patch material like GoreTex or Dacron?

Thanks!

Aijt Damle


 
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