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Severe mitral regurgitation: a common occurrence in the aging patient with secundum atrial septal defect
Abstract:
Severe mitral valve regurgitation (MR) which necessitated mitral valve replacement was identified in 19 (3.9%) of 498 consecutive patients (age range 1-83 years) with secundum atrial septal defects (ASD). The incidence of severe MR was significantly higher in patients older than age 50 years, 15 of 98 (15%), than in patients either below 21 years, 1 of 213 (0.4%), or between ages 21 to 49 years, 3 of 187 (2%). The higher frequency and severity of MR in the older ASD patient has not previously been appreciated. The morphology of severe MR in the older ASD patient consists of fibrous thickening and deformity of the mitral leaflets with shortening and thickening of the chordae tendineae. Because of the rarity of severe MR in the young patient with ASD, the mitral valve pathology is still poorly defined.
Insights
Severe mitral regurgitation (MR) is more common in older adults with atrial septal defects (ASD). This study highlights the need to investigate this association further in elderly patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Diagnostics
Background:
- Atrial septal defects (ASD) are congenital heart conditions often diagnosed in childhood.
- Mitral regurgitation (MR) is a potential complication of ASD, but its prevalence in older adults is not well-established.
- Understanding the relationship between ASD and MR is crucial for comprehensive patient management.
Purpose of the Study:
- To determine the incidence of severe mitral regurgitation (MR) in patients with secundum atrial septal defects (ASD).
- To analyze the correlation between patient age and the occurrence and severity of MR in ASD patients.
- To describe the specific mitral valve pathology associated with MR in older ASD patients.
Main Methods:
- Retrospective analysis of 498 consecutive patients diagnosed with secundum ASD.
- Categorization of patients by age groups: <21 years, 21-49 years, and >50 years.
- Assessment of mitral valve function and identification of severe MR requiring intervention.
Main Results:
- Severe MR was identified in 3.9% (19 of 498) of patients with ASD.
- The incidence of severe MR was significantly higher in patients over 50 years old (15% vs. 0.4% in <21 years and 2% in 21-49 years).
- Morphological findings in older patients included thickened, deformed mitral leaflets and shortened chordae tendineae.
Conclusions:
- Severe mitral regurgitation is significantly more prevalent in older adults with secundum ASD than previously recognized.
- The mitral valve pathology in older ASD patients with MR involves leaflet thickening and chordal abnormalities.
- Further research is needed to define the mitral valve pathology in younger ASD patients with MR due to its rarity.