Gatzoulis M A, Redington A N, Somerville J, Shore D F
Royal Brompton Hospital, National Heart & Lung Institute, London, United Kingdom.
Ann Thorac Surg. 1996 Feb;61(2):657-9. doi: 10.1016/0003-4975(95)01043-2.
By assessing current surgical outcome and symptomatic relief, this study attempts to answer whether atrial septal defects in adults should be closed.
Thirty-nine adult patients aged 35.2 +/- 13.6 years underwent operation for an atrial septal defect between June 1988 and June 1994. Indications for closure were symptoms (33 patients) or a significant left-to-right atrial shunt (6 patients). Data were obtained from hospital records, and the latest status of the patients was determined by a written questionnaire.
There were no deaths. Pulmonary embolism in 1 patient was the only complication observed. The QRS duration on the surface electrocardiogram decreased immediately (p < 0.001), and the cardiothoracic ratio on chest radiographs was significantly lower 3 to 6 months after operation (p < 0.001), both findings reflecting improved hemodynamics. No residual shunts were seen on follow-up (mean follow-up, 3.3 +/- 2.2 years). Twenty-seven (81.8%) of the 33 symptomatic patients improved clinically in terms of exercise performance, atrial arrhythmias, or both. Three (50%) of the 6 previously asymptomatic patients reported improved functional capacity post-operatively.
Today, operation for atrial septal defects in adults can be performed with no mortality and low morbidity and results in symptomatic improvement in the majority of patients. Clinical improvement was seen even in patients who considered themselves asymptomatic preoperatively. We advocate closure of atrial septal defects in adult patients with symptoms or significant atrial shunts.
通过评估当前的手术结果和症状缓解情况，本研究试图回答成人房间隔缺损是否应予以闭合。
1988年6月至1994年6月期间，39例年龄为35.2±13.6岁的成年患者接受了房间隔缺损手术。闭合的指征为有症状（33例患者）或存在明显的左向右心房分流（6例患者）。数据来自医院记录，通过书面问卷确定患者的最新状况。
无死亡病例。仅观察到1例患者发生肺栓塞这一并发症。体表心电图的QRS时限立即缩短（p<0.001），术后3至6个月胸部X线片上的心胸比率显著降低（p<0.001），这两项结果均反映了血流动力学的改善。随访期间未见残余分流（平均随访3.3±2.2年）。33例有症状患者中的27例（81.8%）在运动能力、房性心律失常或两者方面临床症状得到改善。6例先前无症状患者中的3例（50%）报告术后功能能力有所改善。
如今，成人房间隔缺损手术可实现无死亡率、低发病率，且大多数患者症状改善。即使是术前自认为无症状的患者也出现了临床改善。我们主张对有症状或存在明显心房分流的成年患者闭合房间隔缺损。
