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Ostium primum atrial septal defect in the adult
Insights
Surgical correction of ostium primum atrial septal defects (ASD) in adults can lead to asymptomatic outcomes. This intervention may prevent serious complications like arrhythmias and atrioventricular block common in this condition.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Ostium primum atrial septal defects (ASD) are congenital heart abnormalities.
- These defects can lead to significant symptoms and complications in adulthood.
- Primum ASDs are associated with a higher risk of arrhythmias and atrioventricular block compared to secundum ASDs.
Purpose of the Study:
- To evaluate the outcomes of surgical correction for adult patients with ostium primum ASD.
- To assess the potential of surgical intervention in preventing long-term complications.
Main Methods:
- Case series presentation of seven adult patients with ostium primum ASD.
- Review of clinical presentation, catheterization findings, and surgical outcomes.
- Follow-up assessment of patient status post-surgical correction.
Main Results:
- Seven symptomatic adults (average age 41) with large, low ostium primum ASDs and cleft mitral valves were studied.
- One patient developed pulmonary hypertension; one died of unrelated causes.
- Six patients remained asymptomatic at an average follow-up of 3.5 years after surgical correction.
Conclusions:
- Surgical correction of ostium primum ASD in adults appears to be effective in achieving asymptomatic status.
- Early surgical intervention may prevent the high incidence of arrhythmias and atrioventricular block associated with this defect.
- This series suggests surgical correction can alter the natural history of ostium primum ASD, improving long-term prognosis.
Abstract:
Seven adults with ostium primum atrial septal defect (ASD) are presented. All but one patient were symptomatic at the time of diagnosis with the average age being 41 years. At catheterization each had a large, low ASD, left-to-right shunt, and a cleft mitral valve leaflet with minimal regurgitation. Pulmonary hypertension occurred in one. Six patients are asymptomatic an average of 3.5 years after surgical correction. One patient died of other causes at 18 months. Rapid decompensation secondary to arrhythmias or atrioventricular block occurs much more frequently with primum than with secundum ASDs, approaching 80% by age 45. Follow-up in this series suggests that surgical correction may prevent these developments.