title: Mitral valve regurgitation after atrial septal defect repair in adults.
abstract: OBJECTIVE
  Mitral valve regurgitation (MR) is known to deteriorate following adult atrial septal defect (ASD) repair in the mid to long-term. The study aim was to identify the risk factors for this deterioration.
  
  
  METHODS
  Between 1995 and 2011, a total of 93 consecutive patients (aged > or = 18 years) underwent ASD repair at the authors' institution. Patients who underwent concomitant procedures, other than tricuspid annuloplasty or maze procedure, were excluded; hence, 74 patients were enrolled in the study. MR was evaluated by transthoracic echocardiography shortly after surgery and subsequently on a regular basis in the outpatient clinic. Risk factors for the deterioration of MR were estimated using Cox proportional hazards regression.
  
  
  RESULTS
  The mean patient age at surgery was 48.0 +/- 17.1 years, and 20 patients (27%) had atrial fibrillation (AF) preoperatively. The mean follow up was 6.9 +/- 5.5 years. The degree of MR was not unchanged or not improved in 54 patients (73.0%) (group 1), but was increased by one grade in 12 patients (16.2%) (group 2), and by two or more grades in eight patients (10.8%) (group 3). At surgery, all patients in group 3 were aged > 50 years. In group 3, on echocardiography, the average end-diastolic left ventricular dimension was increased from 41.8 mm to 51.8 mm (p = 0.027), and enlargement of the mitral annulus was noted in seven patients. Four of the group 3 patients required reoperation for MR after ASD repair. The Cox proportional hazards model revealed preoperative AF (p = 0.045, hazard ratio (HR): 11.68, 95% confidence interval (95% CI): 1.05-129.48) and Qp/Qs > or = 2.8 (p = 0.015, HR: 9.19, 95% CI :1.53-55.04) to be independent risk factors of new-onset or aggravated MR (by two or more grades) after ASD repair.
  
  
  CONCLUSIONS
  An earlier repair of ASD would be preferable in terms of MR aggravated after ASD repair. For elderly patients with a preoperative high Qp/Qs and AF, mitral valve annuloplasty with ASD repair should considered.
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Numata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Monta
authors.forename: Sachiko
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seo
authors.forename: Takaaki
authors.initials: T
authors.lastname: Samura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Ohashi
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography