Does age matter? Echocardiographic assessment after isolated atrial septal defect surgery

Atrial septal defect is the second most common CHD in adults. This study aimed to evaluate the relationship between age and early postoperative changes in cardiac function-including right ventricular function, tricuspid regurgitation, pulmonary artery pressure, mitral regurgitation, and left ventricular ejection fraction-in adult patients undergoing surgical atrial septal defect repair.

This retrospective study included 214 patients aged 16-65 years who underwent isolated atrial septal defect repair between 2014 and 2024. Patients were divided into five age groups. Echocardiographic parameters were compared at three time points: preoperative, 1-month, and 6-month postoperative.

Of the patients, 60.7% were female. A significant postoperative left ventricular ejection fraction decrease was observed only in the 56-65 age group. Preoperative tricuspid regurgitation severity and pulmonary artery pressure values increased with age, but both showed significant postoperative improvement across all age groups. Postoperative pulmonary artery pressure reduction was most prominent in the youngest and oldest groups. Mitral regurgitation was mildly increased in all groups, without progression to moderate severity. Tricuspid annular plane systolic excursion values, inversely correlated with age, decreased in younger patients postoperatively but improved in older patients, indicating enhanced right ventricular function after volume unloading.

Surgical atrial septal defect repair leads to early improvement in several cardiac parameters. However, the benefit is more pronounced in younger patients. These findings support early surgical intervention to preserve right ventricular function and prevent long-term complications, particularly in asymptomatic adults.