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Circumclusion of atrial septal defect in elderly patients
Insights
Surgical closure of atrial septal defect (ASD) using the circumclusion method is effective in patients over 40. This procedure offers significant benefits, including reduced pulmonary artery pressure and improved heart function, making it a viable option for elderly patients.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Devices
Background:
- Atrial septal defect (ASD) of the secundum type is a congenital heart condition.
- Surgical intervention for ASD in elderly patients presents unique challenges and considerations.
- The circumclusion method (ad modum Søndergaard) is a surgical technique for ASD closure.
Purpose of the Study:
- To evaluate the efficacy and safety of the circumclusion method for surgical closure of secundum ASD in patients over 40 years of age.
- To assess postoperative outcomes, including hemodynamic changes, complications, and long-term results.
Main Methods:
- A cohort of 28 patients aged over 40 with secundum ASD underwent surgical closure using the circumclusion method.
- Postoperative follow-up included hemodynamic assessments, evaluation of complications, and assessment of heart size and rhythm.
Main Results:
- One perioperative death occurred due to cerebral embolism in a patient with pulmonary hypertension and atrial fibrillation.
- Frequent complications included transient atrial arrhythmias and post-pericardiotomy syndrome.
- Pulmonary artery pressures decreased in all patients; pulmonary vascular resistance significantly reduced in two.
- 75% of patients showed improvement at an average 44-month follow-up, with 20 experiencing reduced heart size.
- Two of eight patients with pre-existing atrial fibrillation achieved stable sinus rhythm postoperatively.
Conclusions:
- The circumclusion method is an effective surgical approach for secundum ASD closure in elderly patients.
- Surgical repair of ASD in older individuals is recommended to improve clinical outcomes.
- Despite potential complications, the benefits of ASD closure outweigh the risks in this patient population.
Abstract:
The results of surgical closure of atrial septal defect of secundum type (ASD) in 28 patients over 40 years of age with a closed method, circumclusion ad modum Søndergaard, are presented. One death occurred in the postoperative period caused by cerebral embolism in a patient with increased pressure in the pulmonary artery and atrial fibrillation. The most frequent postoperative complications were transient atrial arrhythmias and the post-pericardiotomy syndrome. The pressures in the pulmonary artery decreased in all patients, who had increased pressures pre-operatively. In two patients with pulmonary vascular resistance of 6 mmHg/l/min before operation the resistance was significantly reduced postoperatively. Residual shunts of less than 30% of the systemic flow were present in 4 cases. The ASD recurred years after the operation in two patients. At follow-up examinations on an average 44 months after operation, 75% had improved. In 20 cases the heart was reduced in size. In the remaining 6 the heart size was unchanged or larger, in spite of eliminated shunts in 5 of the 6 patients. Of 8 patients with atrial fibrillation before operation, two gained stable sinus rhythm postoperatively. It is concluded that circumclusion is also an effective method in the elderly patient with ASD and that such patients should undergo surgical repair of the defect.