Later results of closure of secundum atrial septal defect in children

Abstract

Seventy-one children aged 2 to 17 years (mean 8.8) underwent operation for atrial septal defect and have been followed up for 5 to 13 years (mean 8.2). The condition of the rare symptomatic patient has improved, and weight gain and growth have been striking in the few who had previously shown underdevelopment. Congestive heart failure has not recurred in the 3 patients who had it before operation. Forty-six patients have shown a return of heart size to normal by X-ray study, 61 a shift of the frontal plane QRS axis to the left and a decrease in the height of the R or Rt́ wave in lead V 1, and 30 of 37 a disappearance of electrocardiographic evidence of right ventricular enlargement. Twenty-two patients (31 percent), although asymptomatic, have residual evidence of cardiac enlargement, 15 by X-ray study alone, 3 by electrocardiogram alone, and 4 by both methods. Complete or partial reversion of both roentgenographic and electrocardiographic abnormalities occurs within 1 1 2 to 2 years postoperatively, and no change is seen thereafter. Persistent postoperative cardiac enlargement may be due to incomplete repair (2 of 12 patients who underwent recatheterization) or persistent, hemodynamically significant arrhythmias occurring as a complication of surgery (3 patients). Primarily it is the result of apparent failure of myocardial disease to regress and can be considered a cardiomyopathy of volume loading. Although abnormal physiologic indexes were not demonstrated in all postoperative catheterization studies, some patients showed evidence of loss of myocardial compliance. In those with residual cardiac enlargement, there was no significant positive correlation with the magnitude of the left to right shunt, increase in preoperative right-sided pressure, size or location of the defect, degree of preoperative cardiac enlargement or age at which operation was performed. Results to date suggest that although early closure of an atrial septal defect is curative for most, residual myocardial disease in some may ultimately result in a less than normal life expectancy.