This study reviews the current method of
atrial septal defect closure at our institute with a minimally invasive approach without
median sternotomy. From September 1997 to August 1998, 37 patients (13 males, 24 females) with mean age 36.5 years (range 18-67 years) underwent
atrial septal defect closure by right anterior
thoracotomy. Femoral vessels were cannulated through a small groin incision and
extracorporeal circulation was established. Venous drainage was assisted with a centrifugal pump. Aortic crossclamping was performed through the intact chest wall using a special transthoracic clamp with sliding rod design inserted through a separate tiny 3 mm incision in the right second intercostal space in the mid clavicular line. Mean duration of
cardiopulmonary bypass and aortic crossclamp time was 35 +/- 14 and 23 +/- 7 minutes respectively; mean endotracheal intubation time after surgery 6.2 +/- 3 hours; mean ICU stay 10.6 +/- 2.8 hours; mean length of
thoracotomy incision 7.2 +/- 1.8 cm; and, mean
hospital stay 4.2 +/- 1.8 days. There was no post-operative neurological dysfunction or femoral cannulation related complication. There was no perioperative or late mortality. No residual
atrial septal defect was observed by transoesophageal echocardiography in any patient. The procedure described here provides secure closure of the
atrial septal defects in minimally invasive fashion with good results.