c l i n i c a l f o l i o s : n a r r a t i v e





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Atrial Septal Defect: 1

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A 22-year-old man presented with chest pain, fatigue and decreased stamina. A known murmur since adolescence was not previously worked up. EKG was consistent with an atrial septal defect and the diagnosis was confirmed on an echocardiogram with bubble study. The fatigue and decreased stamina, but not the chest pain, were attributed to the ASD. The patient was taken to the operating room for repair of the defect. A dual lumen internal jugular catheter was used for monitoring rather than a Swan-Ganz, because the latter lies in the way of the repair.     

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Atrial Septal Defect: 2

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The chest was opened through a median sternotomy (see coronary artery bypass) and the patient was put on full bypass. The usual dual stage venous cannula that goes through the right atrial appendage into the inferior vena cava has holes in both the right atrium and IVC. It does not manage return flow from the superior vena cava, and lies across the interatrial septum, blocking access. Therefore venous cannulae are placed in both SVC and IVC, with Rummel tourniquets to return all venous blood to the pump and preserve a dry atrial field.   

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Atrial Septal Defect: 3

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The suction tip is shown demonstrating the orifice of the coronary sinus (see heart anatomy). Retrograde cardioplegia, which would be administered through the coronary sinus, is not used for atrial septal defects and patent fossa ovales because the cannula would be in the way of the repair. Since most of the patients have normal coronary arteries, good preservation is obtained by using antegrade. These patients also have a very short crossclamp time, and a second or subsequent shot of cardioplegia is not needed.   

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This page was last modified on 11/18/2002.