Closure of Atrial Septal Defects Benefits Older Patients

For patients over 40 years of age, surgical closure of an atrial septal defect can improve clinical status and prevent right ventricular dilatation and insufficiency, according to a report by Polish researchers.

Dr. M. Jemielity and colleagues from the University of Medical Sciences, Poznan, studied the long-term outcomes of 76 men and women 40 to 62 years of age, who underwent surgical repair of atrial septal defects. The patients were followed for between 1 and 17 years, according to the team’s report in the March issue of Heart.

Before the operation, 61.8% of the patients were in the New York Heart Association (NYHA) functional classes III and IV. After the procedure, 82.4% were in classes I and II, the researchers report.

In addition, before surgery 52 patients had intensified pulmonary vascularity, but after surgery only seven had the condition, and all patients had a significant reduction in right ventricle size. Atrial fibrillation was present in four patients before the operation and in nine after the procedure.

One patient died during the operation and another patient died late in the study period, the investigators note. “The low mortality and morbidity in patients over 40 years of age who have been operated on for atrial septal defects is a strong argument in support of surgical versus medical treatment,” Dr. Jemielity and colleagues believe.

Commenting on the report by Dr. Jemielity’s group in a journal editorial, Dr. Gary Webb from the University of Toronto, draws a distinction between symptomatic and asymptomatic patients.

“If a patient with atrial septal defects is symptomatic, at any age closure will usually improve life quality, often strikingly. If the patient is asymptomatic, there is no clear evidence to guide a decision against closure, although in my adolescent and adult practice, and based on extensive personal experience, I will continue to recommend closure at any age to most patients with a ‘significant’ defect,” Dr. Webb writes.

Heart 2001;85:330-303,249-250.