Chapter 2581: Another Approach

Under normal circumstances, the secundum foramen closes after the child is born. Once the child is born, the left atrium pressure exceeds the right atrium, directly pressing the patch onto the foramen and closing it.

The fear lies in those people whose defect is too large, and the patch is not big enough to cover it, leaving it incompletely closed. This kind of person occupies a certain percentage of the population, and it’s not low, reaching twenty to thirty percent. Another major category of atrial septal defect occurs here, called secundum atrial septal defect.

Upon hearing this, some people find it hard to believe that so many suffer from this disease because there’s seldom news around them about such patients.

This is because, for most of these people, the aperture of the defect is very small, basically not affecting cardiac hemodynamics and thus, patients are asymptomatic, unexamined, and undiscovered. Even if discovered, it does not impact human health, and medically is deemed unnecessary for intervention. No need to go under the knife for no reason, right?

The group that needs surgery is symptomatic. These symptoms are based on the defect being large, with too much blood flowing from the left atrium to the right atrium, causing pulmonary hypertension. Persistent pulmonary hypertension can evolve into organic lung disease, causing the blood in the right atrium to repress into the left atrium and left ventricle, resulting in left heart failure and cyanosis, known as Eisenmenger syndrome. Reaching this stage, we know from previous cases it’s quite troublesome and can only resort to lung transplant.

If surgery is needed, it should be done early, timely detection and timely resolution. The issue is that this disease is typically detected in an electrocardiogram or chest X-ray only after pulmonary hypertension or arrhythmia appears.

Even if the defect is large, during childhood this type of disease mostly manifests as susceptibility to colds, without other significant symptoms, and cannot be detected in ordinary health check-ups.

In adolescence, some symptoms appear, manifesting as more prone to shortness of breath compared to the average person.

Our people commonly categorize these patients as having weak constitutions, without considering there’s an organic disease inside. The main reason is that the examination projects are too simple, not targeted, and unable to perform necessary screening.

These patients can continue to live until severe pulmonary hypertension develops. Symptoms become increasingly serious after the age of forty, and only then do diagnostics reveal the need for echocardiography. If pulmonary hypertension misses the surgical window, life expectancy is reduced by ten to twenty years.

In terms of treatment, interventional surgeries have brought the option of interventional closure techniques. Like other interventional surgeries, there are conditions and thresholds for interventional procedures. If the defect’s location is not good or the defect’s shape is peculiarly complex, interventional surgery is not possible, and surgery must be chosen.

The gender prevalence ratio for this disease is that females are more than twice as likely as males to be affected.

Bed 12 girl, admission examination shows echo dropout in the central part of the atrial septal, measuring about 30mm, with color flow indicating left-to-right shunt at the atrial level. The defect is large with irregular edges, interventional surgery not feasible, referred to surgery.

Heart surgery mostly follows the previous practice of median sternotomy for two cases. Today, I overheard the teachers discussing the potential use of a right-side axillary lateral thoracotomy.

In early direct-view cardiac surgery, a lateral incision was actually used. Later, it was found that opening the sternum exposed the surgical field excellently, facilitating operation for doctors. Some very complex heart diseases can only be operated on by opening the sternum.

In modern times, right-side incisions have reappeared in the cardiac surgery field, due to the discovery that using right-side incisions for not-so-complex heart diseases poses no issues, and the surgical scar under the armpit is easily hidden, covered by the dropped arm, fulfilling patients’ aesthetic pursuits.