SURGICAL REPAIR FOR ATRIAL SEPTAL-DEFECT IN PATIENTS OVER 70 YEARS OFAGE

Atrial septal defect (ASD) is the most common congenital heart anomaly encountered in adults. For patients over 60 years old, acceptable ope rative mortality and symptomatic improvement following surgery have be en reported. We reviewed patients with ASD aged over 70 years and stud ied their preoperative hemodynamics, the surgical procedures used and the results. Between January 1994 and December 1996, 18 patients over the age of 40 years underwent surgical repair of ASD. Four patients we re over 70 years of age (Group A). The other 14 patients were studied as a control group (Group B). We compared the preoperative clinical st atus, hemodynamic data, and surgical results between the two groups. T he postoperative clinical status of Group A was studied during the fol low-up period. The NYHA functional class of the elderly patients was g reater than that of the middle-aged patients. None of the elderly pati ents had pulmonary hypertension. Moderate or severe tricuspid valve re gurgitation (TR) due to annular dilatation was found, and tricuspid an nuloplasty was performed in all four elderly patients. There were no o perative or hospital deaths in either group. The NYHA functional class and TR improved in all the aged patients after surgery. In order to p revent progressive tricuspid annular dilatation due to an intraatrial left to right shunt, surgical closure of ASD should be performed for p hysically active adult patients.