Surgery to break the atrial septum in the emergency

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1. Effect of surgery to break the atrial septum in emergency

There are many congenital heart diseases, especially severe diseases in the neonatal period such as atrial septal aneurysm, requiring atrial septal surgery in cardiovascular emergency to:
Mix blood in the atrium well as in the case of an inversion of the artery with an intact interventricular septum... Decreased right atrial pressure in anomalies of the complete return of the pulmonary vein with limited atrial septal defect, in fulminant pulmonary stenosis Acute or atrophic pulmonary valve disease with intact atrial septum...

2. Indications of atrial septal bypass surgery in cardiovascular emergency

Atrial septal surgery is indicated in the following cardiac emergencies:
Inversion of the artery with an intact interventricular septum or with limited small ventricular septal defect. Completely abnormal pulmonary venous disease with atrial septal defect, limited oval foramen, severe pulmonary hypertension. Fulminant pulmonary valve stenosis. Pulmonary valve atrophy with intact interventricular septum. Atrial septal defect surgery is contraindicated in the following cases
Complicated congenital heart disease that requires and can be repaired immediately. Severe coagulopathy. Severe internal and surgical diseases make the patient unable to have a cardiac catheterization.

3. How is atrial septal surgery performed?

3.1. Atrial septal defect surgery under angiography guidance

The procedure to perform atrial septal defect surgery under the guidance of an angiogram is as follows:
Place the patient in supine position, arms raised overhead. Anesthetize the patient. Fetal vein puncture. The angiogram is placed in the upright position. Insert the catheter or balloon with the lead from the femoral vein to the inferior vena cava, to the right atrium, and then through the foramen ovale to the left atrium. If a catheter is used, withdraw the catheter, leave the lead, then insert the balloon to break the atrial septum into the left atrium with a lead, then withdraw the lead. Inflate the atrial septal balloon with a syringe that dilutes the contrast agent at a rate of 25%. After determining that the tip of the balloon was in the left atrium, inflate the balloon and pull the balloon back from the left atrium to the right atrium. The pull must be strong enough but still sized to avoid pulling too hard that could tear the inferior vena cava. Conversely, if you do not pull the ball with enough force, you will not be able to expand the oval hole. The doctor may repeat this movement several times to make sure the patient's foramen ovale is enlarged.

3.2. Emergency atrial septal defect surgery under ultrasound guidance

Emergency ultrasound-guided atrial septal surgery includes the following steps:
Place the patient in supine position with buttocks propped up. Put the patient to sleep by sedation, mechanical ventilation. Fetal vein puncture. The balloon is inserted from the femoral vein to the inferior vena cava, to the right atrium, and through the foramen ovale to the left atrium under ultrasound guidance. Then check where the balloon head is located by injecting physiological saline along the balloon line (the way into the blood vessels) if air bubbles are found in any position on the ultrasound, the balloon tip is in that position. Inflate the atrial septal balloon with physiological saline. After determining that the balloon head was in the left atrium, the balloon was inflated and then pulled back from the left atrium to the right atrium. The pull must be strong enough but still sized to avoid pulling too hard that could tear the inferior vena cava. Conversely, if you do not pull the ball with enough force, you will not be able to expand the oval hole. The doctor may repeat this maneuver several times to make sure the foramen ovale is enlarged on the echocardiogram. At the end of surgery, the doctor retracts the balloon, then pulls the vascular opener out of the femoral vein, squeezes the femoral vein by hand until the bleeding stops, then compresses it with an elastic bandage.

4. Follow-up after surgery to break atrial septum in cardiovascular emergency

After surgery to break atrial septum in cardiovascular emergency, the following conditions should be monitored:
Monitor pericardial bleeding and acute chest compressions. Monitor femoral artery bleeding at catheterization site: Monitor femoral compression for bleeding or hematoma. Remove the compression bandage after 24 hours. Postoperative echocardiography to check the patient's condition.

5. Complications in surgery to break the atrial septum and how to manage

Complications during surgery to break atrial septum:
Pericardial bleeding: This case requires blood transfusion, pericardial aspiration, surgery when necessary. Venous bleeding due to tear: Need to conduct compression bandage, blood transfusion, surgery when necessary. Cardiac arrhythmia: Treat according to each type of arrhythmia with arrhythmia drugs, electric shock... Complications after atrial septal surgery include: Hematoma at the femoral vein puncture site: Treat by compression bandage, hemostasis... Infarction, embolism: Need to be consulted by specialists to handle each type. In summary, emergency atrial septal bypass is aimed at better atrioventricular blood mixing and reduced right atrial pressure. This condition requires immediate examination to confirm the diagnosis of a life-saving surgical strategy.
Currently, Cardiovascular Center - Vinmec International General Hospital is one of the leading centers in the country for examination, diagnosis, screening and treatment of cardiovascular diseases. Vinmec not only has the convergence of a team of experienced and reputable leading experts in the field of surgical treatment, internal medicine, interventional cardiac catheterization, but also has a system of modern equipment, on par with The most prestigious hospitals in the world such as: MRI 3 Tesla (Siemens), CT 640 (Toshiba), high-end endoscopy equipment EVIS EXERA III (Olympus Japan), high anesthesia system Avace level, Hybrid operating room according to international standards... Especially, with the space designed according to 5-star hotel standards, Vinmec ensures to bring patients the most comfortable, friendly and reassuring comfort. .

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