title: Surgical closure of atrial septal defect in children under two years of age.
abstract: Infants with atrial septal defects are seldom symptomatic and usually require elective surgery between 2 and 4 years of age. However a small minority is symptomatic and management at this age has been controversial. This study evaluated surgical closure of atrial septal defect below 2 years of age. Eighteen infants with a mean age of 13.4 +/- 5.7 months were operated on for secundum atrial septal defect from 1994 to 2001. Fourteen patients were symptomatic with failure to thrive in 7 and recurrent respiratory infections in 7, one had increasing cardiomegaly, and 3 were operated on early for social reasons. The defect was isolated in 11 patients (61%) and the other 7 (39%) had minor associated lesions requiring additional procedures such as ductal ligation, direct closure of a tiny ventricular septal defect, and inspection of the mitral valve. There were no early or late deaths. The postoperative course was complicated by pulmonary problems in 4 cases. Of the 16 patients available for follow-up, 14 were asymptomatic and 2 were symptomatically improved. Most showed a dramatic improvement in growth and development. These gratifying results indicate that consideration should be given to early surgical closure of atrial septal defect in symptomatic infants.
authors.affiliation: Department of Cardiothoracic Surgery, Sri Ramachandra Medical College University Hospital, Porur, Chennai 600116, India. cvskrb@giasmd01.vsnl.net.in
authors.forename: Usha
authors.initials: U
authors.lastname: Parvathy
authors.forename: Komarakshi R
authors.initials: KR
authors.lastname: Balakrishnan
authors.forename: Madathil S
authors.initials: MS
authors.lastname: Ranjith
authors.forename: Richard
authors.initials: R
authors.lastname: Saldanha
authors.forename: Mahesh
authors.initials: M
authors.lastname: Vakamudi
mesh_terms: D000367:Age Factors; D006332:Cardiomegaly / Q000209:etiology; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome