Atrial Septal Defect Closured by Hypothermic Ventricular Fibrillation Technique Without Cardioplegic: A First Experience Case Report

Abstract

Atrial Septal Defect Closured by Hypothermic Ventricular Fibrillation Technique Without Cardioplegic: A First Experience Case Report

Nipolin Sonoki MD1, Bermansyah MD, FIATCVS2, Gama Satria MD, FIATCVS 2, Ahmat Umar MD, FIATCVS 2 Aswin Nugraha MD, FIATCVS 2, Arie Hasiholan MD, FIATCVS 2, Indra Hakim Nasution MD, FIATCVS 2

1Resident of Cardiothoracic and Vascular Surgery, Dr. Moh. Hoesin Hospital, Faculty of Medicine Sriwijaya University, Palembang, Indonesia

2Department of Cardiothoracic and Vascular Surgery, Dr. Moh. Hoesin Hospital, Faculty of Medicine Sriwijaya University, Palembang, Indonesia

Introduction: Atrial septal defect (ASD) is a common congenital heart disease1, accounting for 10% to 15% of all forms of congenital cardiac malformations2. In cardiac surgery, there are cardioplegic methods (blood or crystalloid cardioplegia, antegrade or retrograde infusion of cardioplegia) and non-cardioplegic methods (ventricular fibrillation or beating-heart technique). Hypothermic ventricular fibrillation during cardiac surgery has some benefits3.

This report is to explain the first experience of closure atrial septal defect with hypothermic ventricular fibrillation technique without cardioplegic.

Case presentation: A seven-years girl, body weight 14 kilograms, with a history of shortness of breath since birth, was diagnosed with large secundum ASD at seven months old. Shortness of breath and palpitations were aggravated during activity. Since birth, she has difficulty in weight gaining. Her echocardiography concluded large atrial septal defect secundum with mild pulmonal regurgitation and mild tricuspid regurgitation. An ASD closured was done by using hypothermic ventricular fibrillation technique without cardioplegic becauseintraoperatively could not do cardioplegic cannulation due to small and short aorta. Cannulation in Aorta, SVC and IVC. The CPB machine was activated and cross clamp off was done. Temperature was set in 32o C. The heart became ventricular fibrillation, right atrium was opened, and ASD closured with pericardial patch. De-airing of left heart and the temperature was increased normally. Aorta cross clamped off and the heart rhythm was sinus. Aox time was 21 minutes. The right atrium then closed and the Cardiopulmonary bypass machine weaning till its stop.Postoperative the patient was early extubated and good recovery. One day after surgery evaluation, the echocardiography results showed no residual of ASD.

Discussion:

In this patient we use hypothermic ventricular fibrillation technique intraoperatively because could not do cardioplegic cannulation due to small and short of aorta. Pendse et al. suggests that beating-heart ASD closure is safe and requires no compromises in comparison with conventional techniques. Outcome of hypothermic ventricular fibrillation as an alternative to conventional cardio protection did not have worse outcomes or more serious adverse events. Cardioplegic arrest inevitably produces some degree of reperfusion injury.  Keeping the heart beating results in less of myocardial oedema and better myocardial function.4

Conclusion: This hypothermic ventricular fibrillation technique without cardioplegic is an alternative method of myocardial protection in cardiac surgery. This technique is relatively safe and can be used during cardiac surgery with good outcome for the patient.