Lakhdhar R, Drissa M, Drissa H
Tunis Med. 2013 Apr;91(4):243-7.
Atrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood.
To describe clinical and likelihood picture of adults over 60 years born with an ASD type II.
We performed a retrospective study of adult'sASD referred toourinstitutionfrom 1985 through 2010. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. On follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire
Among forty ASD type II manifested in adulthood which were referred to our department of cardiology five cases of ASD manifested in the sixth decades (2 men and 3 women). Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Slight anterior chest deformity was present in the older patient. Systolic murmur was found in the 3rd left intercostals space and the pulmonary second heart sound was accentuated in all patients. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. There was marked cardiomegaly in four patients. The pulmonary arteries were markedly enlarged and the peripheral vascular markings were increased. Echocardiographic data revealed large secundum ASD (mean 20 mm, ranged between 10 and 30mm), severe systolic pulmonary pressure in two cases (>5O mmhg). MeanQP/QS was 2.2 and contrast revealed bidirectional shunt in one patient. All patients were studied by venous cardiac catheterization. They showed a significant increase in the oxygen content of right atrial blood. Three patients underwent surgical atrial septal defect closure under general anesthesia. There were no operative or peri operative deaths. At mean follow up of 50±75 months, there was one late death from heart failure in a patient with advanced preoperative heart failure. The oldest patient is in the medical group and he is 75years old. Most survival patients remain in good clinical condition. Some of them were symptomatic at the last follow up and complained of shortness of breath on effort and palpitations in two cases. Two patients were in chronic atrial fibrillation developed during follow up. However, chest RX showed reduction in cardiothoracic ratio postoperatively. Echocardiographic examination confirmed that there was no residual shunt in across the atrial septum in any patient. Systolic pulmonary pressure felled only in 2 patients in the surgery group.
To our knowledge, thesepatients havealongue life span, although survivors with ASD described in the world. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60years. Given the higher risks of surgery in advanced age, the defect should be repaired as early as possible to prevent hemodynamic complications.
房间隔缺损（ASD）是成年期最常见的先天性心脏病病因之一。
描述60岁以上出生时患有II型ASD的成年人的临床及可能情况。
我们对1985年至2010年转诊至我院的成年ASD患者进行了回顾性研究。回顾了临床、心电图、超声心动图和血流动力学数据。在随访研究中，通过超声心动图、心电图对患者进行检查，并通过问卷评估生活质量。
在转诊至我院心内科的40例成年期表现的II型ASD中，有5例ASD在60多岁时表现出来（2例男性和3例女性）。4例患者的主诉为呼吸困难和心悸，仅1例患者有胸痛。年龄较大的患者存在轻度前胸畸形。在第3肋间左间隙发现收缩期杂音，所有患者肺动脉第二心音亢进。所有病例均发现完全性右束支传导阻滞和右心室肥厚。3例患者出现心房颤动。4例患者有明显心脏扩大。肺动脉明显增粗，外周血管纹理增多。超声心动图数据显示大型继发孔型ASD（平均20mm，范围在10至30mm之间），2例患者有严重的收缩期肺动脉压（>50mmHg）。平均肺循环血流量/体循环血流量为2.2，造影显示1例患者有双向分流。所有患者均接受了静脉心导管检查。结果显示右心房血氧含量显著增加。3例患者在全身麻醉下接受了房间隔缺损修补手术。无手术或围手术期死亡。平均随访50±75个月，1例术前有晚期心力衰竭的患者死于心力衰竭。年龄最大的患者在医疗组，他75岁。大多数存活患者临床状况良好。其中一些患者在最后一次随访时有症状，2例患者主诉用力时气短和心悸。2例患者在随访期间出现慢性心房颤动。然而，胸部X线显示术后心胸比率降低。超声心动图检查证实所有患者房间隔均无残余分流。手术组仅2例患者收缩期肺动脉压下降。
据我们所知，尽管世界上有关于ASD存活者的描述，但这些患者寿命较长。对于60岁以上患有ASD的成年人，缺乏关于治疗选择的证据。鉴于高龄手术风险较高，应尽早修复缺损以预防血流动力学并发症。
