SHOULD ATRIAL SEPTAL-DEFECTS IN ADULTS BE CLOSED

Background. By assessing current surgical outcome and symptomatic reli ef, this study attempts to answer whether atrial septal defects in adu lts should be closed. Methods. Thirty-nine adult patients aged 35.2 +/ - 13.6 years underwent operation for an atrial septal defect between T une 1988 and June 1994. Indications for closure were symptoms (33 pati ents) or a significant left-to-right atrial shunt (6 patients). Data w ere obtained from hospital records, and the latest status of the patie nts was determined by a written questionnaire. Results. There were no deaths. Pulmonary embolism in 1 patient was the only complication obse rved. The QRS duration on the surface electrocardiogram decreased imme diately (p < 0.001), and the cardiothoracic ratio on chest radiographs was significantly lower 3 to 6 months after operation (p < 0.001), bo th findings reflecting improved hemodynamics. No residual shunts were seen on follow-up (mean follow-up, 3.3 +/- 2.2 years). Twenty-seven (8 1.8%) of the 33 symptomatic patients improved clinically in terms of e xercise performance, atrial arrhythmias, or both. Three (50%) of the 6 previously asymptomatic patients reported improved functional capacit y postoperatively. Conclusions. Today, operation for atrial septal def ects in adults can be performed with no mortality and low morbidity an d results in symptomatic improvement in the majority of patients. Clin ical improvement was seen even in patients who considered themselves a symptomatic preoperatively. We advocate closure of atrial septal defec ts in adult patients with symptoms or significant atrial shunts.