Atrial septal defect post surgical prognosis


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

Overview
Post-surgical prognosis depends on type of defect, amount of shunting, age at surgery and pulmonary pressure. Early mortality is approximately 1% in the absence of pulmonary hypertension or other major comorbidities. Long-term follow-up is excellent, and preoperative symptoms decrease or abate. The incidence of atrial fibrillation/flutter is reduced when concomitant antiarrhythmic procedures (eg, Maze) are performed; however, atrial arrhythmias may occur de novo after repair.The need for reoperation of residual/recurrent ASD is uncommon. Superior vena cava stenosis or pulmonary vein stenosis may occur after closure of sinus venosus ASD.

Age at surgery and pulmonary pressure
1) Age ≤ 25 years- Survival rates comparable to age and sex-matched control subjects.

2) Age 25-40 years - Surgical survival reduced compared to surgical repair ≤ 25 years 2) Age ≤ 45 years + no comorbidities like heart failure, pulmonary artery pressures ≤60 mm Hg. - Mortality rate post surgery ≤1%.
 * Pulmonary artery pressures are normal- survival comparable with surgery done at ≤ 25 years.
 * Pulmonary artery pressure ≥40 mm Hg- Late survival 50% less than control rates

3) Age ≥ 60 years + no serious comorbidities - Atrial septal defect should be closed as early as possible as surgery can cause an improvement in symptoms

4) Life expectancy in surgically treated older patients is better than that of medically treated patients.

5) Patient's age at time of surgical closure is a good predictor of development of atrial arrhythmias as complications.

6) Atrial fibrillation, stroke, and heart failure common after surgical repair in adult.

Post-surgical arrhythmias
1) Surgical closure during childhood - Late onset supraventricular arrhythmias. The reason for these could be:
 * Patchy fibrosis of the right atrium secondary to dilatation
 * SA node dysfunction

2) Surgical closure in adults -


 * Atrial fibrillation may continue post surgery and require cardioversion and antiarrhythmics treatment.
 * Age at surgery ≥40 years- 1/2 patients with preoperative normal sinus rhythm will develop postoperative atrial fibrillation.

3) Common in the sinus venosus type than in the ostium secundum type.