The Effect of Surgical Treatment for Secundum Atrial Septal Defect in Patients More Than 30 Years Old
Background. We prospectively examined whether surgical treatment of secundum atrial septal defects in patients ? 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect.
Methods. We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation.
Results. The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period.
Conclusions. Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.
Borow KM, Karp R. 1990. Atrial septal defect: lessons from the past, directions for the future. N Engl J Med 323:1698-1700.nBrickner ME, Hillis D, Lange RA. 2000. Congenital heart disease in adults. N Engl J Med 242:256-63.nCampbell M. 1970. Natural history of atrial septal defect. Br Heart J 32:820-6.nCheng TO. 1992. The natural course of atrial septal defect in adults—a still unsettled issue. Clin Invest 70:85.nCraig RJ, Seizer A. 1968. Natural history and prognosis of atrial septal defect. Circulation 37:805-15.nDalen JE, Haynes FW, Dexter L. 1967. Life expectancy with atrial septal defect. JAMA 200:442-6.nDave KS, Pakrashi BC, Wooler GH, Ionescu MI. 1973. Atrial septal defect in adults. Clinical and hemodynamic results of surgery. Am J Cardiol 31:7-13.nDriscoll D, Allen HD, Atkins DL, et al. 1994. Guidelines for evaluation and management of common congenital cardiac problems in infants, children, and adolescents. A statement for healthcare professionals from the Committee on Congenital Cardiac Defects of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 90:2180-8.nFiore AC, Naunheim KS, Kessler KA, et al. 1988. Surgical closure of atrial septal defect in patients older than 50 years of age. Arch Surg 123; 965-7.nGhosh S, Chatterjee S, Black E, Firmin RK. 2002. Surgical closure of atrial septal defects in adults: effect of age at operation on outcome. Heart 88:485-7.nHairston P, Parker EF, Arrants JE, Bradham RR, Lee WH Jr. 1974. The adult atrial septal defect: results of surgical repair. Ann Surg 179:799-804.nHawe A, Rastelli GC, Brandenburg RO, McGoon DC. 1969. Embolic complications following repair of atrial septal defects. Circulation 39(suppl2):185-91.nKirklin JW, Barratt-Boyes BG. 1992. Atrial septal defect and partial anomalous pulmonary venous connection. In: Kirklin JW, Barratt-Boyes BG, eds. Cardiac Surgery, 2nd ed. New York, NY: Churchill-Livingstone: 609-44.nKonstantinides S, Geibel A, Kasper W, Just H. 1991. The natural course of atrial septal defect in adults—a still unsettled issue. Klin Wochenschr 69:506-10.nKonstantinides S, Geibel A, Olschewski M, et al. 1995. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 333:469-73.nMurphy JG, Gersh BJ, McGoon MD, et al. 1990. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 323:1645-50.nNasrallah AT, Hall RJ, Garcia E, Leachman RD, Cooley DA. 1976. Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results. Circulation 53:329-31.nPerloff JK. 1995. Surgical closure of atrial septal defect in adults. N Engl J Med 333:513-4.nRichmond DE, Lowe JB, Barratt-Boyes BG. 1969. Results of surgical repair of atrial septal defects in the middle-aged and elderly. Thorax 24:536-42.nShah D, Azhar M, Oakley CM, Cleland JG, Nihoyannopoulos P. 1994. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J 71:224-7; discussion 228.nShaheen J, Alper L, Rosenmann D, Klutstein MW, et al. 2000. Effect of surgical repair of secundum-type atrial septal defect on right atrial, right ventricular, and left ventricular volumes in adults. Am J Cardiol 86:1395-7.nShibata Y, Abe T, Kuribayashi R, et al. 1996. Surgical treatment of isolated secundum atrial septal defect in patients more than 50 years old. Ann Thorac Surg 62:1096-9.nSt. John Sutton MG, Tajik AJ, McGoon DC. 1981. Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circulation 64:402-9.n
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