Atrial septal defect prognosis


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; ; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
The prognosis for most atrial septal defect patients, especially prior to the age of 40, is positive. As atrial septal defect patients age, symptoms and complications may advance and influence quality of life. With surgical intervention, the mortality rate is less than 1% for atrial septal defect patients under 45. Surgical intervention in older populations is equally promising and can result in longer longevity and improvements in quality of life. Left untreated, the prognosis for atrial septal defect patients is significantly less favorable and may lead to earlier death.

Prognosis

 * Most atrial septal defect patients live to advance in age.


 * If an atrial septal defect is detected and diagnosed early in life, surgery is most successful when performed at 2-4 years of age.


 * As atrial septal defect patients age, mortality rates of surgical intervention repair increases linearly with age and pulmonary artery pressure.


 * The mortality rate for surgical intervention repair is less than 1% for atrial septal defect patients under the age of 45, with no history failure or pulmonary artery pressure issues.


 * Repair is normally only performed in youth with clinically significant complications. Surgery is still advised for all patients with uncomplicated ASDs with clinically significant shunting from left-to-right. Patients with normal pulmonary artery pressure have comparable age- and sex-matched 30-year survival rates until the age of 40.


 * Patients with pulmonary artery pressure issues may experience a lower survival rate.


 * Life expectancy in surgical therapy older patients, though, is better than that of patients with medical therapy. In a small population of patients over the age of 60, presenting without comorbodities, still benefit from surgical intervention.


 * In general, surgical intervention of an ASD is associated with an increase in mortality. However, the age of the patient at the time of surgical closure is the single most important predictor of development of potentially serious life-threatening comorbidities.


 * Most types of atrial septal defects, when repaired with surgical intervention, are associated with low mortality and low morbidity risks.


 * In children, surgical repair can even result in reduction in the right ventricular size from abnormal to closer to normal. Size reduction is not as common in adults with only 20% of all repairs experiencing changes in dimensions. Patients with tricuspid regurgitation and right ventricular failure may experience lifelong symptoms and may have differed long-term outcomes.


 * Complications are more common in older atrial septal defect patients after surgical intervention. It is believed that prognosis is influenced by the long-term effect of volume overload on the chambers of the right side. It is also associated with the volume overload as a result of right atrial enlargement and of pulmonary hypertension. These particular strains on the right chamber of the heart lead to increased risk for atrial arrhythmia and stroke. As many as 22% of late deaths can be attributed to cerebrovascular events. Age at repair as well as preoperative status, such as NYHA class III and IV heart failure, are independent predictors of mortality.