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. 1993 Dec;69(818):912–915. doi: 10.1136/pgmj.69.818.912

Secundum atrial septal defect repair: long-term surgical outcome and the problem of late mitral regurgitation.

M E Speechly-Dick 1, R John 1, W B Pugsley 1, M F Sturridge 1, R H Swanton 1
PMCID: PMC2400019  PMID: 8121863

Abstract

This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up. Fifty-two patients underwent repair by direct suturing and three by patch closure. Surgical mortality was nil. There was one late death of a 58 year old who died from cardiac failure 4 years after surgery. Late postoperative morbidity consisted of two patients; one, age 63 at the time of surgery, required mitral and tricuspid valve replacement 6 years later and one, age 77 at surgery, developed cardiac failure 3 years later. Atrial fibrillation persisted in the six patients who had the rhythm before surgery and developed postoperatively in two patients aged 54 and 58. Two patients aged 49 and 57 developed immediate postoperative sinus node dysfunction requiring permanent pacing. The mean age at surgery of those six patients who suffered cardiac morbidity was 60 years. The patients with preoperative angiographic evidence of mitral valve prolapse were significantly older (P < 0.001) and had higher mean pulmonary artery pressures (P < 0.001) than patients with normal valves. There was no significant relationship between shunt size and mitral valve prolapse. Echocardiographic follow-up showed persistent mitral valve prolapse in all nine patients who developed the condition preoperatively. Five patients developed mitral valve prolapse with mitral regurgitation postoperatively, one of whom needed subsequent mitral and tricuspid valve replacement. These five patient were on average older (mean age 54) but the group was too small to prove significance. The follow-up data illustrate the current low mortality and morbidity associated with surgical closure of atrial septal defects. Late postoperative echocardiography had revealed not only that mitral valve prolapse persists in those patients who developed the condition pre-operatively but that new cases of mitral valve prolapse with mitral regurgitation can occur after atrial septal defect closure.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Betriu A., Wigle E. D., Felderhof C. H., McLoughlin M. J. Prolapse of the posterior leaflet of the mitral valve associated with secundum atrial septal defect. Am J Cardiol. 1975 Mar;35(3):363–369. doi: 10.1016/0002-9149(75)90028-4. [DOI] [PubMed] [Google Scholar]
  2. Campbell M. Natural history of atrial septal defect. Br Heart J. 1970 Nov;32(6):820–826. doi: 10.1136/hrt.32.6.820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dickinson D. F., Arnold R., Wilkinson J. L. Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J. 1981 Jul;46(1):55–62. doi: 10.1136/hrt.46.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hancock E. W., Cohn K. The syndrome associated with midsystolic click and late systolic murmur. Am J Med. 1966 Aug;41(2):183–196. doi: 10.1016/0002-9343(66)90015-5. [DOI] [PubMed] [Google Scholar]
  5. John Sutton M. G., Tajik A. J., McGoon D. C. Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circulation. 1981 Aug;64(2):402–409. doi: 10.1161/01.cir.64.2.402. [DOI] [PubMed] [Google Scholar]
  6. Leachman R. D., Cokkinos D. V., Cooley D. A. Association of ostium secundum atrial septal defects with mitral valve prolapse. Am J Cardiol. 1976 Aug;38(2):167–169. doi: 10.1016/0002-9149(76)90144-2. [DOI] [PubMed] [Google Scholar]
  7. Murphy J. G., Gersh B. J., McGoon M. D., Mair D. D., Porter C. J., Ilstrup D. M., McGoon D. C., Puga F. J., Kirklin J. W., Danielson G. K. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med. 1990 Dec 13;323(24):1645–1650. doi: 10.1056/NEJM199012133232401. [DOI] [PubMed] [Google Scholar]
  8. Perloff J. K. Ostium secundum atrial septal defect--survival for 87 and 94 years. Am J Cardiol. 1984 Jan 15;53(2):388–389. doi: 10.1016/0002-9149(84)90486-7. [DOI] [PubMed] [Google Scholar]
  9. Pomerance A. Ballooning deformity (mucoid degeneration) of atrioventricular valves. Br Heart J. 1969 May;31(3):343–351. doi: 10.1136/hrt.31.3.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Schreiber T. L., Feigenbaum H., Weyman A. E. Effect of atrial septal defect repair on left ventricular geometry and degree of mitral valve prolapse. Circulation. 1980 May;61(5):888–896. doi: 10.1161/01.cir.61.5.888. [DOI] [PubMed] [Google Scholar]
  11. Wilcken D. E., Hickey A. J. Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery. Circulation. 1988 Jul;78(1):10–14. doi: 10.1161/01.cir.78.1.10. [DOI] [PubMed] [Google Scholar]

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