Atrial septal defect.

Abstract

A total of 696 patients with atrial septal defect (ASD) of either the secundum (90.5%) or the sinus venosus (9.5%) type were operated on at the Mayo Clinic from 1954 through 1965. Pulmonary hypertension (PHT, defined as pulmonary artery systolic pressure of 60 mm Hg or greater) or chronic congestive cardiac failure (CCF) (or both) was associated with 80% of the hospital deaths. For the years 1958 through 1965 (531 cases), the hospital mortality for these three groups was 10% (three of 30), 14% (one of seven), and 18% (two of 11), respectively; only two (0.4%) of the remaining 483 patients died, and both were more than 45 years old (among a total of 93 patients more than 45 years old). There have been no operative deaths among those less than 45 years of age and without PHT or CCF (390 cases) in the years 1958 through 1965. No operative deaths occurred in the years 1963 through 1965. Of 16 patients 60 years or older (1954 through 1965), one has died. A 6- to 12-year follow-up was possible on 397 patients operated on from 1954 through 1960. In the absence of PHT or CCF, 330 survived operation. Among the 53 patients more than 45 years old, four died later (not definitely related to closure of ASD), three were not well, 32 were in excellent health, and 14 were lost to follow-up in 1966. Among the 277 patients less than 45 years old, 10 died later (all but one probably unrelated to closure of ASD), three were unwell, 186 were in excellent health, and 78 were lost to follow-up in 1966. Forty-two patients with PHT survived operation in the period from 1954 through 1960. Ten had pulmonary resistance of more than 640 dynes sec cm -5 ; four of these were well, two had died (with PHT), two had severe PHT, one was in CCF, and one was moderately disabled. Thirty-two had pulmonary resistances of 640 dynes sec cm -5 or less; three of these had died (unrelated to closure of ASD), five were moderately disabled, 16 were in excellent health, and eight were lost to follow-up in 1966. Eighteen patients with CCF survived operation in the period from 1954 through 1960. All had had grade IV disability (New York Heart Association classification). There were three late deaths (one due to severe pulmonary vascular disease and two unrelated to closure of ASD), one patient had grade IV disability, five had grades I to II disability, eight were in excellent health, and one was lost to follow-up in 1966. Paroxysmal arrhythmia occurred in 75 of 397 patients (19%) operated on from 1954 through 1960. In 53 patients it was present preoperatively and persisted postoperatively in 15 of them (28%); in an additional 22 it appeared for the first time after closure of the ASD.