Surgical management of atrial septal defect in patients over 40 years of age

Objective: Atrial septal defect (ASD) makes up about 10% of all congenital heart diseases diagnosed after delivery and up to 30-40% of heart defects diagnosed in patients aged over 40 years. The objective of this study was to evaluate the effects of surgical ASD repair on functional status, right ventricular size, cardiothoracic ratio and pulmonary hypertension in patients over 40 years of age.
Methodology: Between the period of August 2001 and August 2010, 20 of the patients who had undergone surgical repair of a secundum ASD when they were aged >40 years at our institution were included in this study. To evaluate the effects of surgery on clinical outcome, we compared functional status, echocardiographic and radiographic findings of the patients before and after surgery. The defect was closed with either a running nonabsorbable suture or an autologous pericardial patch.
Results: Postoperatively, clinical status of the patients improved significantly. The mean NYHA functional class decreased from 2.8�0.4 to 1.5�1.1 (P < 0.001). Postoperatively, mean right ventricle diameter was found regressed from 38.2� 9.3 mm to 34.8�6.2 mm (P < 0.002) at a median interval of four months. The pulmonary artery pressures were also significantly decreased (p < 0.002).
Conclusion: The data provided by this study suggest that surgical repair of ASD improves functional status and relieves symptoms. Therefore, we suggest that ASDs that are unsuitable for transcatheter closure or requiring additional surgical intervention should undergo surgical repair to reduce subsequent morbidity and mortality, in patients including over 40 years of age.