Isolated atrial septal defect with pulmonary vascular obstructive disease - long-term follow-up and prediction of outcome after surgical correction

P. M. Steele, V. Fuster, M. Cohen, D. G. Ritter, D. C. McGoon

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260 Scopus citations

Abstract

We examined the cases of 702 patients found to have isolated atrial septal defect of the secundum or sinus venosus type at catheterization from 1953 to 1978. Forty patients (6%), 34 women and six men, had pulmonary vascular obstructive disease, with a total pulmonary resistance greater than 7 U/m2; of these patients 26 (mean age 47 years) underwent surgical closure and 14 (mean age 44 years) received medical treatment. All patients were followed for at least 4 years, with a median follow-up of 12 years. At the most recent follow-up, 17 of the 40 patients were dead. Of the 22 surgically treated patients with total pulmonary resistance less than 15 U/m2, 19 were alive with significant regression of symptoms. All four surgically treated patients with total pulmonary resistance greater than or equal to 15 U/m2 were dead. Of the five medically treated patients with total pulmonary resistance less than 15 U/m2, four had died, and one was alive with significant progression of symptoms. Of the nine medically treated patients with total pulmonary resistance greater than or equal to 15 U/m2, six had died and the three survivors had progression of symptoms. In the surgically treated group, the following variables correlated with survival: total pulmonary resistance (p < .00001), pulmonary arteriolar resistance (p < .00001), pulmonary-to-systemic resistance ratio (p = .004), systemic arterial oxygen saturation (p = .005), and pulmonary arterial oxygen saturation (p = .007). In conclusion: (1) Atrial septal defect with high total pulmonary resistance is uncommon and predominates in adult female patients. (2) Total pulmonary resistance (or pulmonary arteriolar resistance) is the best predictor of surgical outcome. In patients with total pulmonary resistance less than 15 U/m2, surgical treatment is advised. (3) In patients with borderline total pulmonary resistance, the systemic arterial oxygen saturation provides a good prediction of surgical outcome.

Original languageEnglish
Pages (from-to)1037-1042
Number of pages6
JournalCirculation
Volume76
Issue number5
DOIs
StatePublished - 1987

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