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This study reports on 205 adults with congenital heart defects undergoing total correction. While most patients improved, specific complex lesions and myocardial fibrosis presented significant challenges and mortality factors.
Area of Science:
- Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Congenital heart lesions require surgical correction for improved outcomes.
- Adults with complex congenital heart disease present unique surgical challenges.
Purpose of the Study:
- To evaluate the outcomes of total correction for various congenital heart lesions in adults.
- To identify factors associated with operative mortality and limited success.
Main Methods:
- Retrospective analysis of 205 adult patients undergoing surgical correction.
- Assessment of operative and long-term mortality rates.
- Identification of specific lesions and complications impacting results.
Main Results:
- Overall operative mortality was 3%, with a significant decrease in recent years (1 death in 85 patients).
- Good hemodynamic and symptomatic improvement was observed in most patients.
- Cyanotic tetralogy of Fallot, severe pulmonic stenosis with atrial septal defect, and ostium primum atrial septal defect were associated with poorer outcomes.
- Myocardial failure from fibrosis was the primary cause of operative mortality.
Conclusions:
- Total correction of congenital heart lesions in adults can achieve good results.
- Myocardial fibrosis and irreversible pulmonary changes are key limitations to successful surgical correction.
- Complex lesions require careful consideration for surgical planning and risk stratification.
Abstract:
A total of 205 adults with a variety of congenital heart lesions underwent operation for total correction of their defects. Operative and long-term mortality were 3 and 4 percent, respectively. There has been only one operative death in the past five years (85 patients). While most defects were repaired with good hemodynamic and symptomatic improvement, the three lesions associated with the worst results were cyanotic tetralogy of Fallot, severe pulmonic stenosis complicated by atrial septal defect, and ostium primum atrial septal defect. Myocardial failure due to end-stage myocardial fibrosis was the major cause of operative mortality. Myocardial fibrosis and irreversible pulmonary changes seemed to be the two factors limiting operative correctio