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KMID : 0364019920250111318
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Korean Journal of Thoracic and Cardiovascular Surgery
1992 Volume.25 No. 11 p.1318 ~ p.1326
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Surgical Repair of Isolated Secundum Atrial Septal Defect -Clinical features, hemodynamic function, early and late results according to age at operation-
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이섭
최병철/안욱수/허용/김병열/이정호/유회성
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Abstract
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Backgroud. To determine the influence of age at operation upon surgical outcome in patients with isolated secundum atrial septal defect, retrospective clinical analysis was done.
Material and method . From June, 1976 to December, 1991, 146 patients, 63 male and 83 female patients ranging in are from 13 months to 56 years, were operated on for isolated secundum atrial septal defect. The patients were divided into 3 groups
according to their age at operation group I (<20 years old), 91 patients(62.3%) ; Group II(21 to 40 years old), 44 patients(30.1%) ; Group III(>41 years old), 11 patients(7.6%). Significant differences in clinical features, hemodynamic function,
early
and late results between age groups were speculated.
Results. One hundred thirty- one patients(89.7%) were symptoamatic at the time of operation, the most commons symptoms being dyspnea on exertion, recurrent respiratory infection, palpitation and chest pain. Patients in NYGHA class III or IV were
3.3% in
group I, 25% in groupIII, and 54.5% in groupIII, Hemodynamic data was available for 138 patients (94.5%). Significant pulmonary hypertension(MPA systolic pressure)≥40mmHg) was noted in 22 patients (15.9%). Patients with pulmonary vascular
disease
(Rp/Rs>1.25) were 2% in group I, 7.3% in group II, and 91% in group III. But there were no significant differences between the age groups in the size of the shunt or the ratio of pulmonary to systemic flow. Atrial septal defects were closed with
direct
suture in 144 patients and patch repair was performed in 2 patients with high defect. Atrial arrhythmia (8.2%) was the most common postoperative complication. The mean(±SD) duration of follow-up in all patients was 16±22 months (range, 1-96
months).
Functional results was excellent regardless of the age groups.. During follow-up period, late cardiovascular events were arrhythmia(7 cases), reoperation for recurrent ASD (2 cases), and premature late death due to bacterial endocarditis(1
cases),
incidence of preoperative and late atrial fibrillation was significantly higher in older age group.
Conclusion. Age at operation is one of the most important predictor of early and late surgical outcome with its impact on the following factors : 1) hemodynamic alterations and ventricular dysfunction due to longstanding volume and pressure
overload, 2)
pulmonary vascular disease, and 30 atrial arrhythmia including trial fibrillation s a results of atrial dilatation. Therefore,. Among patients with surgically repaired atrial septal defects, those operated on over the age of 20 require careful
supervision on the long-term basis.
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KEYWORD
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