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Primum atrial septal defect in children: early results, risk factors, and freedom from reoperation
H K Najm1, W G Williams, S Chuaratanaphong
1Department of Surgery, The Hospital of Sick Children, University of Toronto, Faculty of Medicine, Ontario, Canada.
Insights
Repairing primum atrial septal defects in children has favorable outcomes. Infants face higher risks of death and reoperation, with left atrioventricular valve issues being a key concern.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- Primum atrial septal defects (ASDs) in children typically have low operative mortality.
- A subgroup of children with congestive heart failure presents a higher risk.
- This study retrospectively analyzes outcomes for primum ASD repair in children.
Purpose of the Study:
- To determine early mortality rates in children undergoing primum ASD repair.
- To assess the incidence of reoperation in this pediatric population.
- To identify risk factors for mortality and reoperation after primum ASD repair.
Main Methods:
- Retrospective analysis of 180 children who underwent primum ASD repair between 1982 and 1996.
- Patients' ages ranged from 1 month to 16.4 years, with 23 infants (<1 year).
- Categorized patients based on symptom severity, including those with congestive heart failure.
Main Results:
- Early mortality was 1.6% (3/180), with 2 deaths in infants.
- Actuarial survival reached 98% at 10 years, with no late deaths.
- Reoperation was needed in 9% (17/180) for subaortic obstruction or left atrioventricular valve regurgitation; younger age and preoperative valve regurgitation predicted reoperation.
Conclusions:
- Surgical repair of primum ASDs in children yields favorable results.
- Infants represent a high-risk group for both mortality and reoperation.
- Late complications like left atrioventricular valve insufficiency and subaortic stenosis are manageable through reoperation.
Background:
Repair of primum atrial septal defect in children usually is associated with a low operative mortality, except for a subgroup of children with congestive heart failure. To determine the early mortality and incidence of reoperation in children with primum atrial septal defect, we analyzed retrospectively the results of patients who underwent repair of this defect.
Methods:
Between July 1982 and December 1996, 180 children underwent repair of primum atrial septal defect. The mean age at repair was 4.6 years (median, 3.6 years; range, 1 month to 16.4 years); of the 180 children, 23 were infants less than 1 year of age. Absent or mild symptoms were present in 145 (80%), whereas 34 (20%) of children presented with severe symptoms or congestive heart failure.
Results:
Early mortality occurred in 3 (1.6%); 2 were less than 1 year of age. Follow-up ranged from 2 months to 14.5 years (mean, 6 +/- 4.2 years). Actuarial survival is 98% at 10 years with no late deaths. Age less than 1 year is a predictor of death. During follow-up, 17 (9%) of the 180 patients underwent reoperation, 5 of whom were in the infant group. Five underwent reoperation for subaortic obstruction, and 12 for left atrioventricular valve regurgitation of whom 11 were repaired; and 1 required valve replacement. Age and preoperative moderate-to-severe left atrioventricular valve regurgitation were predictors of reoperation.
Conclusions:
Results of the repair of primum atrial septal defect during childhood are favorable. Infants have a higher risk for death and reoperation. Left atrioventricular valve insufficiency and subaortic stenosis are important late complications and can be repaired safely at reoperation.