Surgical treatment of the atrial septal defect in adults: effective reduction in cardiac size and excellent overall clinical outcome.
OBJECTIVE
Atrial septal defect (ASD), one of the commonest congenital heart lesions, is asymptomatic in most cases and therefore remains undiagnosed until adulthood in a significant number of patients. Despite the employment of transcatheter modalities in its treatment, surgery remains a reliable alternative. This study summarizes our experience in surgical correction of ASD in adult patients.


METHODS
Over a 9-year period (September 1997-August 2006), 171 patients, 73 males and 98 females, aged 18-72 (median 35) years, underwent surgical repair of ASDs'. Of these, 141 patients (82%) had ASD of the secundum type and 30 (18%) sinus venosus ASD with partial anomalous pulmonary venous connection (PAPVC). Fifteen patients with different principal diagnoses and concomitant ASD's were excluded, as were those with ostium primum ASDs'. Eighty six patients (50%) were asymptomatic and 11 (6.4%) had established arrhythmias. Two patients had recurrent lesions, 5 had a previously failed attempted transcatheter closure of which 3 were admitted as emergencies. All underwent complete surgical repair.


RESULTS
Two patients (aged 53 and 69 years) with chronic atrial fibrillation suffered embolic strokes (1.16%), with one of the two subsequently dying from cerebral haemorrhage (0.6%). Other postoperative complications (including atrial arrhythmias) were treated successfully. Median ICU and hospital stay were 1 and 6 days respectively. Significant reduction in heart size was noted postoperatively as defined by the reduction in the cardiothoracic ratio (p=0.003). At mean follow up of 55+/-28 months, there was one late death from heart failure in a patient with advanced preoperative disease. All other patients remain in excellent clinical condition.


CONCLUSIONS
Surgical correction of ASD is associated with low morbidity and mortality. Arrhythmias and their complications could be prevented by early surgical treatment.
Chatzis
A
A
Department of Paediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Centre, Athens, Greece.
Giannopoulos
N
N
Vahlas
C
C
Milonakis
M
M
Contrafouris
C
C
Bobos
D
D
Tsoutsinos
A
A
Cousi
T
T
Sofianidou
J
J
Maraki Ccp
P
P
Panagiotou Rn
C
C
Kirvassilis
G
G
Sarris
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D016896:Treatment Outcome; D055815:Young Adult