ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The Results of Surgical Treatment For Secundum Atrial Septal Defects in Elderly
Vedat Erentuğ, Nilgün Bozbuğa, Adil Polat, Nihan Kayalar, Kaan Kırali, Gökhan İpek, Mehmet Balkanay, Esat Akıncı, Mete Alp, Cevat Yakut
Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, İstanbul
Background: Atrial septal defect (ASD) is the most common congenital cardiac anomaly in adults. We evaluated the longterm results of surgical correction of ASDs in patients ≥60 years of age.

Methods: Thirty-six patients (26 women, 10 men; mean age 64.9±3.8 years; range 60 to 80 years) underwent surgery for ASD. Two patients were asymptomatic before surgery. The most common complaint was dyspnea. According to the New York Heart Association (NYHA) functional classification, four patients (11.1%) were class I, seven patients (19.4%) were class II, and 25 patients (69.4%) were class III. Six patients (16.7%) had congestive heart failure, 10 patients had atrial fibrillation or flutter, and 19 patients (52.8%) had tricuspid valve regurgitation. All the patients had pulmonary hypertension (mean 50.5±9.9 mmHg, range 35 to 76 mmHg). The mean pulmonary to systemic flow ratio was 2.6±0.8 (range 1.7 to 5), and the mean cardiothoracic ratio was 0.6±0.1 (range 0.5 to 0.7). Most of the defects (72.2%) were repaired with primary sutures. Eight patients underwent repair and aortocoronary bypass for concomitant cardiac lesions. Intra- and postoperative intrapulmonary nitroglycerine, prostacyclin, and inotropic support were required for hemodynamic stability in six patients, respectively. The mean follow-up was 8.2±4.4 years (range 1 months to 16.9 years).

Results: Twelve patients (33.3%) developed nonfatal complications. Major cardiovascular events were not encountered in 33 patients (91.7%). Functional capacity improved in 30 patients (83.3%) and the median NYHA class decreased from III to I (p<0.005). The mean tricuspid regurgitation decreased from 1.4±1.0 to 0.9±0.4. Pulmonary artery pressure improved in 28 patients (77.8%) and decreased to a mean of 39.7±9.9 mmHg. Mortality occurred in four patients: one patient (2.8%) died in the early period due to severe pulmonary hypertension; one patient died due to severe hypertension in the postoperative period, and late mortality was seen in two patients (5.6%) due to progressive pulmonary vascular disease.

Conclusion: Our results support the view that active elderly patients with ASD should be treated surgically.

Keywords : Aged; atrial fibrillation; heart septal defects, atrial/complications/ surgery
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