Fiore A C, Naunheim K S, Kessler K A, Pennington D G, McBride L R, Barner H B, Kaiser G C, Willman V
Department of Surgery, St Louis University School of Medicine, MO.
Arch Surg. 1988 Aug;123(8):965-7. doi: 10.1001/archsurg.1988.01400320051010.
Between 1962 and 1986, 51 patients 50 years of age or older (mean, 59.7 years; range, 50 to 77 years) underwent operative closure of atrial septal defect. The mean pulmonary vascular resistance was 1.7 +/- 0.79 wood units and the mean pulmonary blood flow-systemic blood flow ratio was 2.8 +/- 1.4. Patch closure with pericardium or Dacron was performed in 36 patients (70%), while 15 patients (30%) underwent primary closure. There were no operative deaths, and one patient was not available for follow-up. The remaining 50 patients (98%) have been followed up for 0.5 to 25 years (mean, 9.6 years). Mean preoperative New York Heart Association classification was 2.40 +/- 0.70. This improved significantly to 1.21 +/- 0.42 at follow-up, with all patients improving by at least one category. No patient received long-term anticoagulation treatment, and no pulmonary or systemic emboli were identified. Two (13%) of 15 patients who underwent primary closure developed septal dehiscence. Actuarial survival was 93%, 86%, and 79% at 5, 10, and 15 years, respectively. Atrial septal defect closure can be safely performed in older patients with excellent results, provided the ratio of systemic to pulmonary blood flow is greater than or equal to 1.5 to 1.0, the pulmonary vascular resistance is low, and the shunt remains left to right. Primary closure should be discouraged, and postoperative anticoagulation therapy appears unwarranted.
1962年至1986年间，51例50岁及以上患者（平均年龄59.7岁；范围50至77岁）接受了房间隔缺损手术闭合治疗。平均肺血管阻力为1.7±0.79伍德单位，平均肺血流量与体循环血流量之比为2.8±1.4。36例患者（70%）采用心包或涤纶补片闭合，15例患者（30%）进行了直接缝合。无手术死亡病例，1例患者失访。其余50例患者（98%）随访了0.5至25年（平均9.6年）。术前纽约心脏协会心功能分级平均为2.40±0.70。随访时显著改善至1.21±0.42，所有患者至少改善一级。无患者接受长期抗凝治疗，未发现肺或体循环栓塞。15例直接缝合患者中有2例（13%）出现间隔裂开。5年、10年和15年的预期生存率分别为93%、86%和79%。对于年龄较大的患者，只要体循环与肺循环血流量之比大于或等于1.5比1.0、肺血管阻力低且分流仍为左向右，房间隔缺损闭合手术可安全进行且效果良好。应避免直接缝合，术后抗凝治疗似乎没有必要。
