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    Under normal circumstances, the pore secundum will close after the child is born.  After the child is born, the pressure in the left atrium is greater than that in the right atrium, so just press the patch onto the hole to erase the hole.

    What I¡¯m afraid of is that for some people, the defect is too big and the patch is not big enough, so it cannot be covered and cannot be closed completely.  Such people account for a certain proportion of the population, and it is not low, accounting for 20 to 30 percent.  Another major type of atrial septal defect occurs here, called secundum atrial septal defect.

    Hearing this, some people couldn¡¯t believe that there were so many people suffering from this disease, because it was rare to hear of such patients around.

    This is because the pores of most of these defects are very small and basically do not affect cardiac hemodynamics. The patients are asymptomatic and do not seek medical treatment and are not discovered. If they are discovered, they will not affect human health. Medically, it is considered that no intervention is needed.  Why go get a stabbing when you have nothing to do, right?

    People who need surgery are symptomatic.  This symptom is due to the large defect area and too much blood pouring from the left atrium into the right atrium, causing pulmonary hypertension. Sustained pulmonary hypertension will evolve into organic pulmonary artery disease, causing the blood from the right atrium to re-pressure into the left atrium.  The ventricle causes cyanosis and other symptoms of left heart failure. This evolution is called Eisenmenger syndrome.  At this point, we knew from previous cases that it was very troublesome and the only option was lung transplantation.

    If you need to have surgery, you must do it as early as possible so that it can be discovered and resolved in time.  The problem is that electrocardiogram or chest X-ray of this type of disease cannot be detected until pulmonary hypertension or arrhythmia occurs.

    No matter how large the defect area is, these patients will most likely show cold-like symptoms in childhood, with no other obvious symptoms and cannot be detected by ordinary physical examination items.

    When I reached adolescence, some symptoms appeared, manifesting as shortness of breath more easily than ordinary people.

    We Chinese people like to classify such patients as physically weak, and never thought that there might be organic diseases in them.  The main reason is still the same. The inspection items are too simple and inappropriate, and the necessary screening cannot be carried out.

    These patients can continue to live without severe pulmonary hypertension.  After the age of 40, the symptoms become more and more serious. At that time, it is finally found out and you know that you need to go for a cardiac ultrasound. If you miss the opportunity for surgery for pulmonary hypertension, your life span will be reduced by ten or twenty years.

    For treatment, there is the option of interventional closure after interventional surgery.  Like other interventional surgeries, there are conditions and thresholds for interventional surgeries.  If the location of the defect is not good and the shape of the defect is strange and complex, interventional surgery is not possible and the only option is surgery.

    The male-to-female incidence ratio of this disease is more than double that of males.

    A 12-bed girl, the admission examination showed a loss of echo in the central part of the interatrial septum, about 30mm in size, and the colored blood flow showed left-right shunting at the atrial level.  The defect is large and the edges are uneven, so interventional surgery cannot be performed.

    Most of the cardiac surgeries were done through the two previous median sternotomy incisions.  I heard the teachers discussing in a low voice today that an incision on the right side of the chest, under the armpit, and on the lateral side of the chest may be used.

    In the early days of open-heart surgery, lateral incision was actually used. Later, it was discovered that incision through the sternum to expose the surgical field is very convenient for doctors to operate. Some very complex heart diseases can only be performed through incision through the sternum.

    In modern times, right-sided incisions have returned to the heart surgery community again. This is because doctors have found that there is no problem in using right-sided incisions for less complex heart diseases, and the surgical scars left by the incisions in the armpits are easy to hide and are hung down.  The arms are covered, in line with the patient's pursuit of beauty.

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