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    ABSTRACT: The natural history of atrial septal defect becomes increasingly difficult to determine with the number of patients having operations. The expectation of life has been calculated for those surviving their first year by two quite independent methods: (I) from 121 reported necropsies and (2) by calculating the mortality rates each decade from 25 deaths among 167 personal or reported patients followed for 663 patient-years. They were patients rather than the ideal of unselected children, but many were symptomless when first seen and sent only because of their physical signs. The two methods gave close agreement about the percentages still living at the end of each decade, generally within +/- 1 or 2 per cent and only as much as +/- 4.5 per cent in the second decade. With the relatively small numbers involved, such close agreement is probably fortunate. The mortality rates are low for the first two decades, 0.6 and 0.7 per cent per annum. In successive decades they rise from 2.7, to 4.5, to 5.4, and 7.5 per cent per annum. One-quarter have died just before their 27th year, half by their 36th year, three-quarters by 50, and 90 per cent by 60 years. The arithmetical mean age of death is 37.5 +/- 4.5 years. The median is also 37 years. The mode is widely spread through the 3rd to 6th decades. All these figures are better than those for aortic stenosis, coarctation of the aorta, and pulmonary stenosis. In and after the fourth decade they approximate more closely to the figures for aortic stenosis and coarctation but are still better than those for pulmonary stenosis. They are improved on only by those with a persistent ductus.
    Heart 12/1970; 32(6):820-6.
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    ABSTRACT: We prospectively examined whether surgical treatment of secundum atrial septal defects (ASDs) in patients > or =40 years old improves their long-term clinical outcome. Surgical treatment of secundum ASDs in adults > 40 years old is a subject of controversy because of the perception of good long-term clinical outcomes in patients with unrepaired ASDs and the lack of data from randomized trials. We recruited 521 patients > 40 years old with secundum ASDs referred for treatment; 48 were excluded. Patients were randomly assigned to surgical closure (n = 232) or medical treatment (n = 241). The primary and secondary end points were a composite of major cardiovascular events (death, pulmonary embolism, major arrhythmic event, embolic cerebrovascular event, recurrent pulmonary infection, functional class deterioration or heart failure) and overall mortality, respectively. We assessed possible prognostic markers. The analysis was performed on an intention-to-treat basis. The median follow-up period was 7.3 years (range 2 to 13). The risk of having the primary end point was significantly higher in the medical group, which had a univariate hazards ratio of 1.99 (95% confidence interval [CI] 1.23 to 3.22) and a multivariate hazards ratio of 1.85 (95% CI 1.08 to 3.17). Although the survival analysis did not reveal differences in overall mortality between the surgical and medical treatments (hazards ratio 1.71, 95% CI 0.76 to 3.86), the multivariate analysis, adjusted by age at entry, mean pulmonary artery pressure and cardiac index, demonstrated significant differences between the study groups (hazards ratio 4.09, 95% CI 1.41 to 11.89). Surgical closure was superior to medical treatment in improving both the composite of major cardiovascular events and overall mortality in patients > 40 years old with secundum ASDs. This superiority was related to the mean pulmonary artery pressure, age at diagnosis and cardiac index. Because of the higher risk of morbidity and mortality, we believe that anatomic closure should always be attempted as the initial treatment for ASDs in adults > 40 years old with pulmonary artery systolic pressure < 70 mm Hg and a pulmonary/systemic output ratio > or =1.7. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seems to be minimal.
    Journal of the American College of Cardiology 12/2001; 38(7):2035-42. · 14.09 Impact Factor
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    ABSTRACT: This study intends to provide a detailed overview of the types and rates of peri-operative complications after surgical correction of an isolated ASD II. The transvenous approach to the occlusion of atrial septal defects has yielded promising results during its first 5 years of clinical trials, but before it can be established as a routine measure, definite proof is needed to demonstrate that its rate of serious complications does at least not exceed that of the surgical closure. Between 1985 and 1992, 232 consecutive patients underwent surgical closure of a secundum atrial septal defect. Among the patients 118 were children (< 18 years; 79 girls and 39 boys) with a mean age of 8.9 +/- 5.2 years (4 months-17 years) and 114 adults (74 women and 40 men) with a mean age of 28.5 +/- 10.8 years (18-69 years). Pre-operatively eight children (6.8%) and eight adults (7%) were treated for right heart failure. Mean pulmonary artery pressure was 20.4 +/- 10.4 mmHg for the children and 19.3 +/- 7 mmHg for the adults. The average pulmonary artery to systemic flow ratios were 2.9:1 and 3:1 for children and adults, respectively. Thirty children (25.4%) and 15 adults (13.2%) underwent patch closure while direct suture was the method used for the remaining patients. Average cardiopulmonary bypass time was 35.7 +/- 17.9 min for the children and 41.5 +/- 19.9 min for the adults. The length of the procedure (skin to skin) was a mean of 116 min in the young group, and 141 min in the adult group.(ABSTRACT TRUNCATED AT 250 WORDS)
    European Heart Journal 11/1994; 15(10):1381-4. · 14.10 Impact Factor

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