BACKGROUND. Atrial septal defects have been surgically correctable for more than 30 years. The long-term survival rates among patients treated in the early era of cardiac surgery are poorly documented, but such data are of critical importance to the future medical care, employability, and insurability of these patients. METHODS. To determine the natural history of surgically corrected atrial septal defects, we studied all 123 patients who underwent repair of an isolated defect (ostium secundum or sinus venosus) at the Mayo Clinic between 1956 and 1960, 27 to 32 years after the procedure. The follow-up status of all patients was determined by written questionnaires and telephone interviews. Hospital records and death certificates were obtained if interim hospitalization or death had occurred. RESULTS. The overall 30-year actuarial survival rate among survivors of the perioperative period was 74 percent, as compared with 85 percent among controls matched for age and sex. The perioperative mortality was 3.3 percent (four deaths). Actuarial 27-year survival rates among patients in the younger two quartiles according to age at operation (less than or equal to 11 years and 12 to 24 years) were no different from rates among controls--97 percent and 93 percent, respectively. In the two older quartiles (25 to 41 years and greater than 41 years), 27-year survival rates were significantly less (P less than 0.001)--84 percent and 40 percent, respectively--than in controls (91 and 59 percent). Independent predictors of long-term survival according to multivariate analysis were age at operation (P less than 0.0001) and systolic pressure in the main pulmonary artery before operation (P less than 0.0027). When repair was performed in older patients, late cardiac failure, stroke, and atrial fibrillation were significantly more frequent. CONCLUSIONS. Among patients with surgically repaired atrial septal defects, those operated on before the age of 25 have an excellent prognosis, but older patients require careful, regular supervision.
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
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106: 1821-1826
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Louagie, Y. A., Blommaert, D., De Roy, L.
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1: 38-40
[Abstract][Full Text]
Hughes, M L, Maskell, G, Goh, T H, Wilkinson, J L
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[Abstract][Full Text]
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Thomson, J D R, Aburawi, E H, Watterson, K G, Van Doorn, C, Gibbs, J L
(2002). Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart
87: 466-469
[Abstract][Full Text]
McMahon, C J, Feltes, T F, Fraley, J K, Bricker, J T, Grifka, R G, Tortoriello, T A, Blake, R, Bezold, L I
(2002). Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart
87: 256-259
[Abstract][Full Text]
Attie, F., Rosas, M., Granados, N., Zabal, C., Buendia, A., Calderon, J.
(2001). Surgical treatment for secundum atrial septal defects in patients >40 years old: A randomized clinical trial. J Am Coll Cardiol
38: 2035-2042
[Abstract][Full Text]
Torracca, L., Ismeno, G., Alfieri, O.
(2001). Totally endoscopic computer-enhanced atrial septal defect closure in six patients. Ann. Thorac. Surg.
72: 1354-1357
[Abstract][Full Text]
Nieminen, H. P., Jokinen, E. V., Sairanen, H. I.
(2001). Late Results of Pediatric Cardiac Surgery in Finland: A Population-Based Study With 96% Follow-Up. Circulation
104: 570-575
[Abstract][Full Text]
Shinohara, T., Kimura, T., Yoshizu, H., Ohsuzu, F.
(2001). Three-year follow-up of an atrial septal aneurysm. Ann. Thorac. Surg.
71: 1672-1673
[Abstract][Full Text]
Wren, C, O'Sullivan, J J
(2001). Survival with congenital heart disease and need for follow up in adult life. Heart
85: 438-443
[Abstract][Full Text]
Jemielity, M, Dyszkiewicz, W, Paluszkiewicz, L, Perek, B, Buczkowski, P
(2001). Do patients over 40 years of age benefit from surgical closure of atrial septal defects?. Heart
85: 300-303
[Abstract][Full Text]
Iivainen, T. E., Groundstroem, K. W.E., Lahtela, J. T., Talvensaari, T. J., Pasternack, A., Uusitalo, A.
(2000). Serum N-terminal atrial natriuretic peptide in adult patients late after surgical repair of atrial septal defect. Eur J Heart Fail
2: 161-165
[Abstract][Full Text]
El-Najdawi, E. K., Driscoll, D. J., Puga, F. J., Dearani, J. A., Spotts, B. E., Mahoney, D. W., Danielson, G. K.
(2000). Operation for partial atrioventricular septal defect: a forty-year review. J. Thorac. Cardiovasc. Surg.
119: 880-889
[Abstract][Full Text]
Nicholson, I. A., Chard, R. B., Nunn, G. R., Cartmill, T. B.
(2000). TRANSCAVAL REPAIR OF THE SINUS VENOSUS SYNDROME. J. Thorac. Cardiovasc. Surg.
119: 741-744
[Abstract][Full Text]
Brickner, M. E., Hillis, L. D., Lange, R. A.
(2000). Congenital Heart Disease in Adults- First of Two Parts. NEJM
342: 256-263
[Full Text]
Berger, F., Vogel, M., Kramer, A., Alexi-Meskishvili, V., Weng, Y., Lange, P. E., Hetzer, R.
(1999). Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann. Thorac. Surg.
68: 75-78
[Abstract][Full Text]
Groundstroem, K.W.E., Iivainen, T.E., Talvensaari, T., Lahtela, J.T.
(1999). Late postoperative follow-up of ostium secundum defect. Eur Heart J
20: 904-909
[Abstract]
Gatzoulis, M. A., Freeman, M. A., Siu, S. C., Webb, G. D., Harris, L.
(1999). Atrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults. NEJM
340: 839-846
[Abstract][Full Text]
RIGBY, M. L
(1999). The era of transcatheter closure of atrial septal defects. Heart
81: 227-228
[Full Text]
Gatzoulis, M. A., Hechter, S., Webb, G. D., Williams, W. G.
(1999). Surgery for partial atrioventricular septal defect in the adult. Ann. Thorac. Surg.
67: 504-510
[Abstract][Full Text]
Meacham III, R. R., Headley, A. S., Bronze, M. S., Lewis, J. B., Rester, M. M.
(1998). Impending Paradoxical Embolism. Arch Intern Med
158: 438-448
[Abstract][Full Text]
Sueda, T., Okada, K., Hirai, S., Orihashi, K., Nagata, H., Matsuura, Y.
(1997). Right Atrial Separation for Chronic Atrial Fibrillation With Atrial Septal Defects. Ann. Thorac. Surg.
64: 541-542
[Abstract][Full Text]
Sharafuddin, M. J. A., Gu, X., Titus, J. L., Urness, M., Cervera-Ceballos, J. J., Amplatz, K.
(1997). Transvenous Closure of Secundum Atrial Septal Defects : Preliminary Results With a New Self-Expanding Nitinol Prosthesis in a Swine Model. Circulation
95: 2162-2168
[Abstract][Full Text]
Shibata, Y., Abe, T., Kuribayashi, R., Sekine, S., Seki, K., Yamagishi, I., Chanda, J.
(1996). Surgical Treatment of Isolated Secundum Atrial Septal Defect in Patients More Than 50 Years Old. Ann. Thorac. Surg.
62: 1096-1099
[Abstract][Full Text]
Massetti, M., Babatasi, G., Rossi, A., Neri, E., Bhoyroo, S., Zitouni, S., Maragnes, P., Khayat, A.
(1996). Operation for Atrial Septal Defect Through a Right Anterolateral Thoracotomy: Current Outcome. Ann. Thorac. Surg.
62: 1100-1103
[Abstract][Full Text]
Aksnes, J., Lindberg, H. L., Ihlen, H.
(1996). Surgical Elimination of an Atrial Septal Aneurysm Causing Cerebral Embolism. Ann. Thorac. Surg.
62: 1190-1192
[Abstract][Full Text]
Gatzoulis, M. A., Redington, A. N., Somerville, J., Shore, D. F.
(1996). Should Atrial Septal Defects in Adults Be Closed?. Ann. Thorac. Surg.
61: 657-659
[Abstract][Full Text]
Ward, C., Henderson, R.A., Sanderson, J. E., Fung, W.H., Cox, J. L., Jaquiss, R. D.B., Konstantinides, S., Geibel, A.
(1996). Atrial Septal Defect. NEJM
334: 56-57
[Full Text]
Lin, F.-Y., Huang, J.-H., Lin, J.-L., Chen, W.-J., Lo, H.-M., Chu, S.-H.
(1996). ATRIAL COMPARTMENT SURGERY FOR CHRONIC ATRIAL FIBRILLATION ASSOCIATED WITH CONGENITAL HEART DEFECTS. J. Thorac. Cardiovasc. Surg.
111: 231-237
[Abstract][Full Text]
Konstantinides, S., Geibel, A., Olschewski, M., Gornandt, L., Roskamm, H., Spillner, G., Just, H., Kasper, W.
(1995). A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults. NEJM
333: 469-473
[Abstract][Full Text]
Perloff, J. K.
(1995). Surgical Closure of Atrial Septal Defect in Adults. NEJM
333: 513-514
[Full Text]
Geggel, R. L., Mark, E. J.
(1993). Case 37-1993- A 48-Year-Old Woman with an Atrial Septal Defect and Pulmonary Hypertension. NEJM
329: 864-872
[Full Text]
Schwartz, J., Leibovitz, A., Berti, B., Baumel, Y., Habot, B.
(1992). Holt-Oram Syndrome in an Elderly Patient A Case History. ANGIOLOGY
43: 706-708
[Abstract]
Morris, C. D., Menashe, V. D.
(1991). 25-Year Mortality After Surgical Repair of Congenital Heart Defect in Childhood: A Population-Based Cohort Study. JAMA
266: 3447-3452
[Abstract]
