Safety and efficacy of atrial septal defect closure on normothermic on-pump beating heart

The a dvancement of per cutaneous intervention technique ha s been a driving fac tor for the development of new surgical t echniques that are less invasive, less traumatic, and safer and covers a broader spectr um of cases, which were previously thought as in operable. Th ough the use of cardi o- pulmonary bypass, hy pothermia and hy perkalemic cardioplegic a rrest gained wide acc eptance yet the deleterious effect of ex tracorporeal circulation and unavoidable ischemic-reperfusion injury of a ortic cross cl amping a nd cardioplegic arrest re sulting i n myocardial e dema and car diac dysfunction could not be avoided. Several new strategies were worked out for better myocardial protection which included the method of san dwiched col d cardioplegia with warm induction a nd terminal hot sh ot, continuous retrograde wa rm blood car dioplegia, i ntermittent antegrade inf usions of w arm blood car dioplegia and e ventually simultaneous antegrade/ r etrograde continuousarm blood cardioplegia1-3