Surgical Treatment of Atrial Septal Defect under Hypothermia.

Since the development of cardiac surgery, defects of the atrial septum have been recognized with increased frequency. During the past 15 years, various surgical techniques have been used, and even to-day the surgical treatment of this lesion is not uniform. In 1948, Murray first closed an atrial septal defect, suturing together the anterior and posterior atrial walls in the septal plane. S0ndergaard, G0tzshe, Ottosen, and Schultz (1955) introduced his circumclusion suture, applied after dissection of the interatrial groove between the cavae and the right pulmonary veins. Bailey, Bolton, Jamison, and Neptune (1953) described his technique of atriopexy, and the following year Gross, Pomeranz, Watkins, and Goldsmith (1952) reported his atrial wall operation. Lewis and Taufic (1953) were the first to close an atrial septal defect with direct vision under hypothermia following the experimental work of Bigelow, and soon after Swan (1953) applied this technique to a large series. The modem management of atrial septal defects has been with the use of extracorporeal circulation, first achieved by Gibbon in 1954, by Lillehei, Cohen, Warden, and Varco (1955), and subsequently used by many workers. Although it is now generally agreed that closed operative techniques are unsatisfactory, there is considerable disagreement as to whether hypothermia or cardiopulmonary bypass should be the method of choice for dealing with the uncomplicated, simpler type of atrial septal defect. Many surgeons, for example C. A. Hufnagel (personal communication, 1960), Gross (1962), and a number of surgeons in this country, recommend bypass for every case of atrial septal defect. They consider the main disadvantage of conventional hypothermia at 30° C. to be the time limit of circulatory arrest thereby imposed, usually accepted as eight to 10 minutes. On the other hand, this should be an adequate period for simple suture of an atrial septal defect, and the use of