[HSF] ASD patch

[prasannasimha]

Ajit,
Did you rule out a sinus venous ASD ? (Since you say there is an 
inadequate superior margin). In that case on external examination the 
SVC RA junction will be larger than normal.
In those cases I usually place a straight (pliant) wire reinforced 
cannula from the RA through the SVC which has been dissected fully and 
taped above the entry of the PV's. This acts as a stent preventing 
iatrogenic SVC obstruction while allowing unbridled access to the PV 
orifices and the patch can be baffled avoidng PV obstruction without 
causing SVC narrowing which is impossible now because the cannula is 
staying there.

Incidentally a straightforward secundum ASD is what we give our 
residents to do as their first case so actually you needn't worry at 
all. It may be unusual for you as these may be closed in childhood but 
is  pretty common here !!
Prasanna
Ajit Damle 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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