SECUNDUM ATRIAL SEPTAL-DEFECT REPAIR - LONG-TERM SURGICAL OUTCOME ANDTHE PROBLEM OF LATE MITRAL REGURGITATION

This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who u nderwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up. F ifty-two patients underwent repair by direct suturing and three by pat ch closure. Surgical mortality was nil. There was one late death of a 58 year old who died from cardiac failure 4 years after surgery. Late postoperative morbidity consisted of two patients; one, age 63 at the time of surgery, required mitral and tricuspid valve replacement 6 yea rs later and one, age 77 at surgery, developed cardiac failure 3 years later. Atrial fibrillation persisted in the six patients who had the rhythm before surgery and developed postoperatively in two patients ag ed 54 and 58. Two patients aged 49 and 57 developed immediate postoper ative sinus node dysfunction requiring permanent pacing. The mean age at surgery of those six patients who suffered cardiac morbidity was 60 years. The patients with preoperative angiographic evidence of mitral valve prolapse were significantly older (P<0.001) and had higher mean pulmonary artery pressures (P<0.001) than patients with normal valves . There was no significant relationship between shunt size and mitral valve prolapse. Echocardiographic follow-up showed persistent mitral v alve prolapse in all nine patients who developed the condition preoper atively. Five patients developed mitral valve prolapse with mitral reg urgitation postoperatively, one of whom needed subsequent mitral and t ricuspid valve replacement. These five patients were on average older (mean age 54) but the group was too small to prove significance. The f ollow-up data illustrate the current low mortality and morbidity assoc iated with surgical closure of atrial septal defects. Late postoperati ve echocardiography has revealed not only that mitral valve prolapse p ersists in those patients,who developed the condition pre-operatively but that new cases of mitral valve prolapse with mitral regurgitation can occur after atrial septal defect closure.