Atrial septal defect in adults

Area of Science:

• Cardiology
• Adult Congenital Heart Disease
• Cardiac Surgery

Background:

• The efficacy of surgical repair for atrial septal defects (ASD) in adults, particularly those over 40, remains a subject of ongoing discussion.
• Unoperated ASD can lead to progressive right heart enlargement and dysfunction.

Purpose of the Study:

• To evaluate the outcomes of surgical closure for atrial septal defects (ASD) in adult patients.
• To compare the results between younger adults (20-40 years) and older adults (over 40 years).

Main Methods:

• A cohort of 57 adult patients with unoperated ASD underwent clinical assessment, echocardiography, and catheterization.
• Patients were divided into two groups: Group A (20-40 years) and Group B (40-62 years).
• Surgical intervention was performed on 40 patients, with detailed pre- and post-operative assessments.

Main Results:

• Older patients (Group B) exhibited more severe symptoms, increased tricuspid regurgitation, and larger right ventricles compared to younger patients (Group A).
• Pulmonary to systemic flow (Qp/Qs) and pulmonary arteriolar resistance (PAR) were similar between groups.
• Surgical closure resulted in zero mortality, improved NYHA classification, reduced tricuspid regurgitation, and decreased right ventricular size in both groups.

Conclusions:

• Surgical closure is recommended for adults with ASD larger than 10 mm (by TEE), right ventricle overload, or Qp/Qs ≥ 1.5, provided PAR is normal.
• While operative mortality is zero across age groups, functional improvement was more pronounced in patients under 40.