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(Circulation. 2005;112:1953-1958.)
© 2005 American Heart Association, Inc.

Congenital Heart Disease

Sinus Venosus Atrial Septal Defect

Long-Term Postoperative Outcome for 115 Patients

Christine H. Attenhofer Jost, MD; Heidi M. Connolly, MD; Gordon K. Danielson, MD; Kent R. Bailey, PhD; Hartzell V. Schaff, MD; Win-Kuang Shen, MD; Carole A. Warnes, MD; James B. Seward, MD; Francisco J. Puga, MD; A. Jamil Tajik, MD

From the Division of Cardiovascular Diseases (C.H.A.J., H.M.C., W.-K.S., C.A.W., J.B.S., A.J.T.), the Division of Cardiovascular Surgery (G.K.D., H.V.S., F.J.P.), and the Division of Biostatistics (K.R.B.), Mayo Clinic, Rochester, Minn.

Reprint requests to Heidi M. Connolly, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Received September 23, 2003; de novo received July 20, 2004; revision received June 2, 2005; accepted June 6, 2005.

Background— Sinus venosus atrial septal defect (SVASD) differs from secundum atrial septal defect by its atrial septal location and its association with anomalous pulmonary venous connection (APVC). Data on long-term outcome after surgical repair are limited.

Methods and Results— We reviewed outcomes of 115 patients (mean age±SD 34±23 years) with SVASD who had repair from 1972 through 1996. APVC was present in 112 patients (97%). Early mortality was 0.9%. Complete follow-up was obtained for 108 patients (95%) at 144±99 months. Symptomatic improvement was noted in 83 patients (77%), and deterioration was noted in 17 patients (16%). At follow-up, 7 (6%) of 108 patients had sinus node dysfunction, a permanent pacemaker, or both, and 15 (14%) of 108 patients had atrial fibrillation. Older age at repair was predictive of postoperative atrial fibrillation (P=0.033). No reoperations were required during follow-up. Survival was not different from expected for an age- and sex-matched population. Clinical improvement was more common with older age at surgery (P=0.014). Older age at repair (P=0.008) and preoperative New York Heart Association class III or IV (P=0.038) were independent predictors of late mortality.

Conclusions— Operation for SVASD is associated with low morbidity and mortality, and postoperative subjective clinical improvement occurs irrespective of age at surgery. Postoperative atrial fibrillation appears to be related to older age at operation. SVASD repair achieves survival similar to that of a matched population and should be considered whenever repair may impact survival or symptoms.

Key Words: heart defects, congenital • heart septal defects • surgery • survival

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