5. Decade of life to patient’s complaints

The heart consists of two atria and two ventricles. Atria and ventricles are connected by leaflet valves, allowing blood to flow from the atrium toward the ventricle but not vice versa. Both atria are adjacent to each other and are separated by a thin wall that physicians call the atrial septum. Normally, blood does not flow from one atrium to the other.

Atrial septal defect (ASD-Atrial septal defect) is a congenital malformation of the partition between the two atria. Thus, there is a hole between the atria through which blood can flow from one to the other cavity.

In unborn babies there is a physiological connection between the two atria, the so-called foramen ovale, which allows blood flow from the right to the left, since the unborn child does not yet need a pulmonary circulation and this is bypassed by the connection between the two atria. From the moment of birth this window begins to close. In some people, however, it persists. This anomaly is called persistent foramen ovale (PFO). This defect is a special variant of the atrial septal defect.

Causes and development

Why some people have an open foramen ovale into adulthood is not well understood. Causes of congenital other malformations of the septum include those associated with alcohol consumption, infections (rubella u.a.) and the intake of medication during pregnancy is connected. Because of the hole between the atria, blood now flows from the left to the right atrium and ventricle. This blood meets the blood already there due to the regular right heart action. There is an increased volume load in the right atrium and ventricle, as well as in the pulmonary circulation.

In the case of small defects, the patients are usually not able to have a heart transplant until they are 40 years old. symptom-free during the first year of life. Due to the aging process with various changes, especially in the heart and circulation, it comes ca. from the 5. Decade of life to complaints of the patient. Impaired performance, rapid fatigue, shortness of breath, strong palpable heartbeat, recurrent pneumonia and cerebral infarction can be caused by atrial septal defect.

In most cases, the doctor hears a certain extra heart murmur when listening to the heart. This may indicate the presence of a defect in the atrial wall. Certain abnormalities in chest X-rays may also suggest this anomaly. That is why echocardiography (ultrasound of the heart) is recommended at this point, where blood flow from the left to the right atrium can be visualized.

The Clinic for Cardiac and Thoracic Surgery in Jena operates on ASD's and PFO's in adolescents (adolescents) and adults. Children are operated on at specialized pediatric cardiac surgery centers. In the conventional method, the sternum is opened to a length of 20 to 30 centimeters so that the surgeon has free access to the heart. In contrast to this method, in MIS surgery the surgeon reaches the heart through a small lateral incision of a few centimeters between the ribs (anterolateral minithoracotomy) without opening the sternum. The heart-lung machine is connected via the femoral vessels (leg arteries and veins) through a 2cm small incision.

The surgeon then works on the stopped heart (blood is oxygenated through the heart-lung machine) under direct vision. The heart valve and the area below the valve are visualized and the surgical measures can be performed with precision.

For educational purposes and to improve the view in certain situations a camera can be brought in. Depending on the size and extent of the defect, it is sutured together directly or a so-called patch (the body's own patch) is sewn onto the hole. The stress on the patient is low with the minimally invasive option. A more favorable cosmetic result is achieved. A smaller wound especially reduces the incidence of wound infections, post-operative bleeding and instability of the sternum.

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