[Prognostic significance of the initial clinical findings in patients over 40 years of age with secundum atrial septal defect].
Controversy concerning medical versus surgical management of elderly patients with secundum atrial septal defect (ASD II) remains unsolved. To clarify this problem, we studied relation between initial clinical findings and long-term prognosis of patients with isolated ASD II over 40 years of age. Of 47 patients medically managed, 13 patients died during the follow-up period. Among these, 11 died of congestive heart failure (CHF), and 2 died of non-cardiac disease. Mean age and follow-up period of these 11 were 68.1 +/- 9.0 and 6.7 +/- 5.1 years, respectively, and those of 34 survivors were 61.9 +/- 7.5 and 7.7 +/- 5.8 years, respectively. All 6 patients of functional capacity III-IV (NYHA classification), and 5 of NYHA II, died. Seven patients of NYHA II progressed to NYHA III-IV, and the other 20 of NYHA II and all 7 patients of NYHA I remained unchanged during the follow-up. Overt CHF (p less than 0.001), mitral and/or tricuspid regurgitation (p less than 0.01), combination with arterial hypertension and/or ischemic heart disease (p less than 0.05), atrial fibrillation (p less than 0.01), P-sinistrocardiale (p less than 0.001), and R/S (V6) less than 2.0 (p less than 0.01), cardiothoracic ratio greater than 55% (p less than 0.001), width of right descending branch of the pulmonary artery greater than 25 mm (p less than 0.01), and mitral valve prolapse in the echocardiogram (p less than 0.05) were significantly frequent in the cases clinical deterioration. Of 32 patients, whose functional capacities were NYHA II initially, 12 showed progression and 20 were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000145:classification / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011652:Pulmonary Circulation