Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016 258 AFRICA
Comparison of primary repair and patch plasty
procedure on the P wave in adult atrial septal defect
closure
Alper Ucak, Veysel Temizkan, Murat Ugur, Ahmet Erturk Yedekci, Omer Uz, Arif Selcuk, Ahmet Turan Yilmaz
Abstract
Introduction: In this study we compared the effects of two
different surgical procedures for closure of adult atrial septal
defect (ASD) on postoperative P-wave changes.
Methods: Patients who underwent cardiac surgery for
secundum type ASD closure were evaluated retrospectively.
Seventy-two patients with primary repair of ASD and 29
patients with pericardial patch plasty repair were compared
according to Pmax, Pmin and P-wave dispersions (Pd).
Results: In each group, the increases in postoperative maxi-
mum P-wave duration (Pmax) and minimum P-wave duration
(Pmin) were statistically significant. There was no statisti-
cally significant difference between post- and pre-operative
Pd values. In the comparison between group 1 and group 2
in terms of postoperative P-wave changes (Pmax, Pmin, Pd) there
was no statistically significant difference.
Conclusion: Comparing patch plasty and primary repair for
the surgical closure of ASD in the early to mid-postoperative
period, no difference was found and both surgical procedures
can be performed in adult ASDs.
Keywords: atrial septal defect, P-wave analysis, arrhythmia
Submitted 17/12/15, accepted 17/2/16
Published online 4/5/16
Cardiovasc J Afr 2016; 27: 258–261
DOI: 10.5830/CVJA-2016-013
Atrial septal defect (ASD) is one of the most common congenital
heart defects in adulthood. It can be repaired percutaneously or
surgically, depending on the defect size. Primary surgical repair
or patch plasty (closure with patch) are the two surgical ASD
closure techniques used depending on diameter of the defect.
Atrial arrhythmias may develop in repaired and unrepaired
ASD patients. The inter-atrial conduction pathway may
influence this, and postoperative arrhythmias may develop due
to increased size of the right atrium in unrepaired patients, or
tension in the suture line in the postoperative period.1 Prolonged
maximum P-wave duration (Pmax) and increased P dispersion
(Pd) may be pioneer indicators of disturbance of the inter-atrial
conduction pathway and atrial fibrillation in ASD patients.2
Many different studies have been carried out for P-wave
changes following ASD closure surgeries. These studies evaluated
the effects of percutaneous or surgical closure techniques on the
P wave after defect repair.3-6 In the literature, there is no study
investigating the effects of surgical ASD closure techniques on
the P wave in adults. In our study, we retrospectively investigated
the electrocardiograms of adult patients who underwent surgical
closure of ASDs and evaluated the effects of both primary
closure and pericardial patch plasty techniques on the P wave.
Methods
The study design was approved by the institutional review board.
Patients who underwent surgical ostium secundum type ASD
closure between the years 2004 and 2014 in the cardiovascular
surgery clinic of the GATA Haydarpasa Training Hospital were
included in the study. Patients with primum ASD and patients
with cardiac pathologies requiring additional surgical treatment
were excluded from the study.
Twelve-lead surface electrocardiograms were collected from
patients’ records who underwent surgical ostium secundum type
ASD closure. The 101 patients were divided into two groups
(Table 1) according to their closure procedure; primary surgical
repair (group 1) and pericardial patch plasty (group 2).
Seventy-two patients without increased atrial stretch and
with a small- to medium-sized defect diameter were evaluated as
suitable for primary surgical repair (group 1) and they underwent
primary surgical repair for ASD closure. Twenty-nine patients
with a larger defect diameter and/or patients with accompanying
sinus venosus type ASD (group 2) underwent the patch plasty
technique for ASD closure. The demographic data of the
patients in each group and their pre- and postoperative five- to
seven-day and three-month 12-lead surface electrocardiogram P
waves were compared.
All surgeries were carried out under general anaesthesia. A
median sternotomy, mini-thoracotomy and mini-sternotomy
were performed in 69, 14 and 18 patients, respectively (Table
2). Cardiopulmonary bypass was achieved by cannulation of
the aorta and double venous cannulation in the right atrium
following median sternotomy, where femoral arterial cannulation
and femoral vein to selected superior vena cava cannulation were
achieved following mini-thoracotomy/mini-sternotomy.
Department of Cardiovascular Surgery, GATA Haydarpasa
Training Hospital, Istanbul, Turkey
Alper Ucak, MD,
Veysel Temizkan, MD
Murat Ugur, MD
Arif Selcuk, ND
Ahmet Turan Yilmaz, MD
Department of Anesthesiology, Kyrenia Military Hospital,
Cyprus
Ahmet Erturk Yedekci, MD
Department of Cardiology, GATA Haydarpasa Training
Hospital, Istanbul, Turkey
Omer Uz, MD