Embolic complications following repair of atrial septal defects.

Abstract

Postoperative embolism occurred in 35 of 546 patients traced for 2 to 15 years after surgical repair of uncomplicated ASD. A total of 58 embolic episodes occurred, resulting in the death of 11 of these 35 patients. The incidence of embolism was not significantly related to the technique used for surgical repair. Six of the nine patients who had had a preoperative embolism also had an embolism in the postoperative period. The most significant factors associated with an increased risk of postoperative embolism were increased age of the patient, atrial fibrillation, and pulmonary hypertension, all of which are interrelated: seventy-seven per cent (27/35) of patients having a postoperative embolism had either atrial fibrillation or pulmonary hypertension, and 77% (27/35) of patients with postoperative embolism were more than 40 years old at the time of the first embolism. Because actuarial analysis suggests that 30% of patients more than 40 years of age who have atrial fibrillation after repair of ASD may have an embolism within 10 years postoperatively, continuation of anticoagulation therapy indefinitely in these patients is suggested. The highest risk of embolism occurs in the early postoperative period, suggesting the advisability of anticoagulation therapy for all adult patients during convalescence.