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[Report of surgical treatment of ASD in the aged]
Insights
Surgical repair of secundum atrial septal defects offers significant benefits for older adults with advanced symptoms. This life-saving procedure improves heart function and quality of life, even with co-existing heart failure or pulmonary hypertension.
Area of Science:
- Cardiology
- Thoracic Surgery
- Adult Congenital Heart Disease
Context:
- Atrial septal defects (ASDs) are common congenital heart anomalies.
- Secundum type ASDs account for the majority of cases.
- Surgical intervention is a primary treatment modality.
Purpose:
- To evaluate the efficacy of surgical closure for secundum atrial septal defects in an older adult population.
- To assess the impact of surgery on functional class, cardiac dimensions, and pulmonary pressures.
Summary:
- Five adult patients (43-67 years) with secundum ASDs underwent surgical repair.
- Pre-operative findings included elevated cardiac-thoracic ratio (CTR), severe heart failure in three, and high pulmonary-to-systemic flow ratio (QP/QS > 3.0).
- Post-operative results showed decreased CTR, normalized pulmonary arterial pressure, and significant symptomatic improvement.
Impact:
- Surgical closure of secundum ASDs is a life-saving intervention for elderly patients.
- The procedure provides sustained clinical benefits, improving functional capacity and alleviating symptoms.
- Surgery is effective even in the presence of advanced symptomatic disability, pulmonary hypertension, or congestive heart failure.
Abstract:
5 surgical cases of atrial septal defect of the secundum type, aged 43, 45, 54, 58 and 67 respectively, are reported. Two of them were initially in functional class III, one in class II and two in class I. CTR were increased in all cases. Three of them had severe heart failure, especially in a 67 years-old patient severe respiratory obstructive disfunction was observed (FEV1.0:0.561). All of the cases had large pulmonary to systemic flow ratio (QP/QS greater than 3.0) and one had pressure-gradient of 20 mmHg between RV and PA. After the surgery CTR decreased, pulmonary arterial pressure also fell to normal value, and all cases symptomatically improved. It is concluded that surgery is life saving and appears to offer sustained clinical benefit to the older age group with advanced symptomatic disability, even if pulmonary hypertension or congestive heart failure are associated.