[Heart condition before and after surgical treatment of atrial septal defect type II in adults].

UNLABELLED

ASD t. II is one of the common congenital heart abnormalities in adults. Early surgical or percutaneous correction in childhood is recommended, but in adults indications to surgical treatment are still controversial. With age physical functional class (NYHA) deteriorating is observed. In the natural course of the defect some patients could be asymptomatic up to third or fourth decade of life and in the middle aged we can observe clinical symptoms.

PURPOSE

The aim of the study was to assess a condition of the heart and analyse some dependences between a value of PASP and degree of NYHA class and other echocardiographic parameters in patients before and after surgical repair of ASD t.ll.

MATERIAL AND METHODS

93 patients were involved in research (24.7% male, mean age 43.8+/-11 years ) with history of isolated ASD t.II. All patients were observed in follow-up (mean range--6.6+/-3.1 years). In all pts. before and after surgery the history of the specific symptoms of dyspnea on exertion, level of fatigue, physical examination with assessment a degree of heart failure (NYHA class), a value of PASP (mmHg), the pulmonary to systemic ratio (Qp/Qs) were performed. The patients were divided into two groups according to their age at the time of surgical correction: I group < 40 years and II group > 40 years. In statistic analysis Chp test, Fisher test, t-Student test and logistic regression model were performed.

RESULTS

In our study we observe a significant improvement of NYHA class in both groups. A marked recovery from class III or IV to class I or II after operation was documented in 24 pts. (47%) in I group (p<0.00001) and 14 pts. (33%) in group II. (p<0.0001). The pulmonary artery pressure decreased significantly after surgery in both groups (33.1+/-7.7 vs 21.9+/-5.1 mmHg; (p<0.0001--I group) and 41.3+/-11.5 vs 23.4+/-6.2 mmHg; (p<0.0001--II group). We did not observe any significant correlations between NYHA class and PASP and also between PASP and Qp/Qs ratio before surgery in studied groups. (p>0.05).

CONCLUSIONS

1. Surgical repair of ASD t.II is an useful treatment in adult pts. because it improves hemodynamic status and normalise PASP independently of age at the time of repair. 2. More intensive symptoms of dyspnea or fatigue assessed by NYHA class do not correspondence with value of PASP in any age before repair. 3. With advanced age a higher degree of NYHA class correlates with increased value of Qp/Qs ratio. 4. Age over 40 years is not a contraindication to surgical treatment.