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Should atrial septal defects in adults be closed?
M A Gatzoulis1, A N Redington, J Somerville
1Royal Brompton Hospital, National Heart & Lung Institute, London, United Kingdom.
The Annals of Thoracic Surgery
|February 1, 1996
Summary
Closing atrial septal defects in adults is safe and effective. Surgery significantly improves symptoms and functional capacity, even in initially asymptomatic patients, with no mortality observed.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Cardiac Surgery
Background:
- Atrial septal defects (ASDs) can persist into adulthood.
- The decision for surgical closure in adults requires evaluation of surgical outcomes and symptomatic relief.
Purpose of the Study:
- To assess the surgical outcomes and symptomatic improvement in adult patients undergoing closure of atrial septal defects.
- To determine the efficacy of ASD closure in improving hemodynamics and functional capacity in adults.
Main Methods:
- A retrospective study of 39 adult patients (mean age 35.2 years) who underwent ASD closure between 1988 and 1994.
- Indications for closure included symptoms or significant left-to-right shunts.
- Patient data were collected from hospital records and follow-up questionnaires.
Main Results:
- No perioperative mortality was observed; one patient experienced pulmonary embolism.
- Significant improvements in QRS duration and cardiothoracic ratio indicated enhanced hemodynamics.
- 81.8% of symptomatic patients and 50% of asymptomatic patients reported clinical improvement post-surgery.
- No residual shunts were detected during a mean follow-up of 3.3 years.
Conclusions:
- Surgical closure of ASDs in adults can be performed with excellent safety and low morbidity.
- The procedure leads to significant symptomatic improvement in the majority of adult patients.
- Closure is recommended for adult patients with symptomatic ASDs or significant shunts.