Long-term follow-up of children after repair of atrial septal defects

BACKGROUND It is critical to repair atrial septal defects during childhood to minimize long-term morbidity and mortality. However, only a few studies have examined factors that predict a favorable outcome.

OBJECTIVE To examine prognostic variables in the repair of atrial septal defects.

METHODS Retrospective analysis of children who underwent repair of atrial septal defects between 1957 and 1981.

RESULTS There were 70 girls and 57 boys with a mean age of 9.3 years at the time of surgery (range 4 months to 20 years). The most common presenting symptoms were fatigue and dyspnea. Before surgery, 74% were in New York Heart Association functional class I, 70% had echocardiographic evidence of right ventricular hypertrophy, and 55% had cardiomegaly on chest radiographs. The average mean pulmonary arterial pressure was 17.1 mm Hg. The only factor significantly related to poor outcome was pulmonary hypertension. Age at surgery did not influence long-term results. Ninety-four percent of patients were in functional class I at follow-up.

CONCLUSIONS Repair of atrial septal defects is safe before age 21, but it should be done as early as possible in order to minimize the long-term complications of chronic left-to-right shunting.