Atrial Septal Defect in the 30 plus age group - should they be treated surgically

Abstract

The progressive development of pulmonary hypertension is inevitable in atrial septal defects. We have carried out a retrospective survey of patients over the age of 30 years who have been referred for surgery in the five year period from 1st November 1989. 48 of the 163 patients were over the age of 30 years. Three were advised against surgical closure; all 3 were over 50 years of age, had significant pulmonary hypertension, and were unlikely to benefit from closure of the defect. Forty five patients between 30 and 47 years underwent surgical closure, with one early death due to liver disease. The higher the patient status according to the NYHA Class, the less likely were they to have a remission of symptoms, although no further clinical deterioration is envisaged in this group. Most of the patients in their early thirties were still likely to have amelioration of their symptoms, and improvement in their cardiac status.