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A 20-year review of ostium primum defect repair in children
Insights
Ostium primum defect repair in children shows low mortality and usually mild mitral insufficiency. However, significant arrhythmias are common, frequently requiring pacemaker implantation.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
Background:
- Ostium primum defects are a type of atrial septal defect.
- Surgical repair is a common treatment for these defects in children.
Purpose of the Study:
- To evaluate the long-term outcomes of ostium primum defect repair in a pediatric population.
- To assess mortality, residual defects, mitral insufficiency, and arrhythmias after surgery.
Main Methods:
- Retrospective review of 69 pediatric patients undergoing ostium primum defect repair between 1963 and 1983.
- Follow-up ranged from 6 months to 20 years, with assessments via cardiac catheterization and noninvasive methods.
Main Results:
- Low perioperative mortality (4/69).
- Mitral insufficiency was mild to trivial in most patients (35/61), with severe insufficiency in 2.
- Significant late arrhythmias occurred in 14/61 patients, with 8 requiring pacemakers.
Conclusions:
- Ostium primum defect repair in children has a low mortality rate.
- While mitral insufficiency is common, it is typically mild and nonprogressive.
- Arrhythmias are a frequent and significant complication requiring intervention, including pacemaker implantation.
Abstract:
Between July, 1963, and July, 1983, a total of 69 patients (35 boys and 34 girls) underwent ostium primum defect repair. There were four perioperative deaths and four patients were subsequently lost to follow-up, leaving 61 children followed for 6 months to 20 years (mean 5 years). Results of surgery were assessed by cardiac catheterization in 17 of 61 patients, while the remaining patients were evaluated noninvasively. Postoperative mitral insufficiency was found to be absent in 19 patients, mild to trivial in 35, moderate in four, and severe in two. Four patients were found to have large residual atrial septal defects. Significant late postoperative arrhythmias were found in 14 of 61 patients. The types of arrhythmias included isolated complete atrioventricular block in 5 of 14, complete atrioventricular block with sinus node dysfunction in 2 of 14, and isolated sinus node dysfunction in 7 of 14. Pacemakers have been implanted in 8 of 14 of these patients. Based on this 20-year review of a large number of children: (1) ostium primum defect repair is associated with a low mortality rate, (2) residual mitral insufficiency although common is usually mild to trivial and nonprogressive, and (3) significant arrhythmias are a frequent complication and often require pacemaker implantation.