RT Journal Article
SR Electronic
T1 The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1346
OP 1352
DO 10.1136/heartjnl-2013-304225
VO 99
IS 18
A1 Judith A A E Cuypers
A1 Petra Opić
A1 Myrthe E Menting
A1 Elisabeth M W J Utens
A1 Maarten Witsenburg
A1 Wim A Helbing
A1 Annemien E van den Bosch
A1 Mohamed Ouhlous
A1 Ron T van Domburg
A1 Folkert J Meijboom
A1 Ad J J C Bogers
A1 Jolien W Roos-Hesselink
YR 2013
UL http://heart.bmj.com/content/99/18/1346.abstract
AB Objective To describe the very long-term outcome after surgical closure of an atrial septal defect (ASD). Design Longitudinal cohort study of 135 consecutive patients who underwent surgical ASD repair at age <15 years between 1968 and 1980. The study protocol included ECG, echocardiography, exercise testing, N-terminal prohormone of brain natriuretic hormone, Holter monitoring and cardiac MRI. Main outcome measures Survival, major events (cardiac reinterventions, stroke, symptomatic arrhythmia or heart failure) and ventricular function. Results After 35 years (range 30–41), survival status was obtained in 131 of 135 patients (97%): five died (4%), including two sudden deaths in the last decade. Fourteen patients (16%) had symptomatic supraventricular tachyarrhythmias and six (6%) had a pacemaker implanted which was predicted by early postoperative arrhythmias. Two reoperations were performed. One ischaemic stroke occurred. Left ventricular (LV) and right ventricular (RV) ejection fractions (EF) were 58±7% and 51±6%, respectively. RVEF was diminished in 17 patients (31%) and in 11 (20%) the RV was dilated. Exercise capacity and quality of life were comparable to the normal population. No clear differences were found between ASD-II or sinus venosus type ASD. Conclusions Very long-term outcome after surgical ASD closure in childhood shows good survival and low morbidity. Early surgical closure prevents pulmonary hypertension and reduces the occurrence of supraventricular arrhythmias. Early postoperative arrhythmias are predictive for the need for pacemaker implantation during early follow-up, but the rate of late pacemaker implantation remains low. Although RVEF was unexpectedly found to be decreased in one-third of patients, the functional status remains excellent.