A NEW method, which uses a specially designed septal punch, has been developed for creating atrial septal defects in the very young, critically ill patient. Although the procedure was specifically designed for creating atrial septal defects in infants with transposition of the great vessels, the technique can also be used to create an interatrial communication in cases of total anomalous pulmonary venous return. The advantages of the method are that the circulation to the right lung is not interrupted at any time and the interatrial septum can first be enlarged to compensate for small anatomical structures and, thus, ensure the creation of a large defect. The method is safe, simple, reliable, and the total operating time should not be more than 30 to 40 minutes.
The Instrument: Atrial Septal Punch (Fig 1)
The instrument was designed to be introduced into the right atrium through a purse string suture and then
POULOS PP, EDELMANN RB. Creation of Atrial Septal DefectsAn Experimental Method and Instrument. Arch Surg. 1966;93(6):974–976. doi:10.1001/archsurg.1966.01330060118014