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[Diagnosis and surgical treatment of atrial septal defects in adults]
1Abteilung Angeborene Herzfehler, Deutsches herzzentrum Berlin. mvogel@dhzb.de
Background And Objective:
The value of surgical closure of an atrial septal defect (ASD) in adults is currently under discussion, because the operative risk is thought to be high and there are no reliable data about postoperative change in quality of life.
Patients And Methods:
The case notes of 205 patients (149 women, 56 men, mean age 41.4 years) in whom an ASD had been surgically closed were analysed retrospectively. Preoperative symptoms, complications, arrhythmias, pulmonary artery pressure and the influence of the operative closure on quality of life (criteria of the New York Heart Association [NYHA]) were noted.
Results:
At the time of diagnosis 138 (66%) of patients had complained of dyspnoea or palpitations, four had sustained a stroke and two had had endocarditis. Atrial fibrillation or flutter was present in 55 (27%). 47 (23%) were in class III or IV (NYHA). Mean age at operation was 42.2 (18-74.9) years. One patient, a woman with pulmonary hypertension, died and one patient suffered a stroke. The number of patients with atrial fibrillation or flutter fell to 31 (15%) postoperatively and 176 patients (86%) moved to a better NYHA class, especially those who had been in class IV.
Conclusions:
These data show that surgical closure of ASD in adults is reasonable, because the operative mortality is low, the quality of life is improved postoperatively and there is a reduced incidence of arrhythmias.