Circulation, Vol 64, 402-409, Copyright © 1981 by American Heart Association
MG John Sutton, AJ Tajik and DC McGoon
Between 1955 and 1977, 66 patients ages 60 years or older underwent
operative closure of secundum atrial septal defect. Of these, 56 (85%) were
catheterized preoperatively. The 56 patients were divided into three groups
to assess the effects of pulmonary hypertension on operative mortality,
symptoms and longevity. The 17 group 1 patients had peak systolic pulmonary
artery pressures (PAPs) of less than 40 mm Hg; the 21 group 2 patients had
PAPs of 40-60 mm Hg; and the 18 group 3 patients had PAPs of more than 60
mm Hg. Among the three groups, there was no significant difference in
Qp/Qs, right or left atrial pressures, right or left ventricular
end-diastolic pressures and Qs, although pulmonary vascular resistance was
significantly higher (p less than 0.01) in group 3 than in group 1. Four
patients died, yielding an operative mortality of 6%. All four patients had
undergone additional operative procedures. Operative mortality was
unrelated to preoperative symptom class, PAP or pulmonary vascular
resistance. Forty-seven patients were followed up for 2-20 years (mean 6.6
years), and of these, 41 (87%) improved by at least one functional class.
Symptomatic benefit occurred in all groups, regardless of preoperative PAP,
pulmonary vascular resistance or functional class. Actuarial survival
curves showed that longevity at 5 and 10 years postoperatively was
significantly increased (p less than 0.01) for patient with atrial septal
defect treated surgically compared with that predicted for age- matched
patients treated medically.
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Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up
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