Natural history of secundum atrial septal defect in adults over 60 years

Abstract

Atrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood and a subgroup of patients may not develop symptoms until late adulthood. The aim of our study was to describe clinical and likelihood picture of adults over 60 years born with an ASD type II. We performed a retrospective analysis of adult's ASD referred to our institution from 2010 through 2018. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. For follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. Among forty ASD type II manifested in adulthood, which were referred to our department of cardiology, five cases of ASD manifested in octogerian. Two men and three woman. Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. Echocardiographic data revealed large secundum ASD (mean 20 mm,), severe systolic pulmonary pressure in two cases and moderate in one case. All patients were studied by venous cardiac catheterisation. The arterial saturation was markedly reduced in patients who had small right to left shunt. Three patients underwent percutaneous atrial septal defect closure. There were no deaths. At mean follow up of 50 months, most survival patients remain in good clinical condition. Two patients were in chronic atrial fibrillation developed during follow up. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60 years. Percutaneous correction of ASD is associated with low morbidity and mortality, and should be as early as possible to prevent hemodynamic complications, such as the development of pulmonary hypertension and cardiac arrhythmias.