Andersen M, Moller I, Lyngborg K, Wennevold A
Am Heart J. 1976 Sep;92(3):302-7. doi: 10.1016/s0002-8703(76)80111-1.
Thirty-nine patients with a small ASD of the secundum type were followed clinically for 5 to 21 years (mean 11.6 years); no evidence of deterioration was found. In 26 of these cases recatheterization was carried out with a mean follow-up period of 9.8 years. No significant changes were found in most patients; in four patients, however, the left-to-right shunt had increased significantly. Our recommendations are that we will continue to advise surgery in patients with large ASD's, whereas we still do not recommend surgery in patients with small ASD's; the latter patients should be followed for longer periods to ensure that no deterioration occurs. The decision as to whether an ASD should be regarded as large or small in our opinion not only should be based on a chosen limit of pulmonary-to-systemic flow ratio, but clinical factors such as diastolic flow murmurs, ECG changes, the heart size, and the pulmonary vascular markings should also be taken into consideration.
39例继发孔型小型房间隔缺损患者接受了5至21年的临床随访（平均11.6年）；未发现病情恶化迹象。其中26例患者进行了再次心导管检查，平均随访期为9.8年。大多数患者未发现显著变化；然而，有4例患者的左向右分流明显增加。我们的建议是，对于大型房间隔缺损患者，我们将继续建议进行手术，而对于小型房间隔缺损患者，我们仍然不建议手术；后者应进行更长时间的随访，以确保病情不会恶化。我们认为，判断房间隔缺损是大是小，不仅应基于选定的肺循环与体循环血流量比值界限，还应考虑舒张期血流杂音、心电图变化、心脏大小和肺血管纹理等临床因素。
