Erkut Bilgehan, Becit Necip, Unlu Yahya, Ceviz Munacettin, Kocogullari Cevdet Ugur, Ates Azman, Karapolat Bekir Sami, Kaygin Mehmet Ali, Kocak Hikmet
Department of Cardiovascular Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey.
Heart Surg Forum. 2007;10(5):E376-80. doi: 10.1532/HSF98.20071059.
We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect.
We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation.
The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period.
Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.
我们前瞻性地研究了30岁以上患者继发孔型房间隔缺损的手术治疗是否能改善其早期和中期临床结局。回顾我们的临床经验以评估老年房间隔缺损患者手术治疗的重要性。
我们分析了41例年龄超过30岁且接受继发孔型房间隔缺损手术矫正的患者。为评估手术治疗效果，我们比较了所有患者手术前后的功能能力、利尿剂使用情况、心律状态和超声心动图参数。
中位随访期为4.2年（范围6个月至7年）。无手术死亡病例。大多数患者术后功能分级改善。两名患者术后恢复为正常窦性心律。术后仅1例新发心房颤动。术后右心房和右心室大小及肺动脉压力显著降低，射血分数显著增加。手术修复后利尿剂治疗需求减少。随访期间未发现残余心内分流。术后早期无脑血管血栓栓塞事件。
30岁以上患者房间隔缺损的手术闭合可改善其临床状况并预防右心室扩张和功能不全。即使症状或血流动力学影响似乎最小，也必须尽早进行手术。
