Atrial septal defect: lessons from the past, directions for the future

Article Abstract:

Atrial septal defects are the third most common form of congenital heart defect, the first two being bicuspid aortic valve and mitral valve prolapse. These defects, in which the septum separating the right and left atria has not fully closed, account for 7 to 10 percent of birth defects of the heart. The condition is usually asymptomatic in patients between the ages of 1 and 10, but as the patient matures, symptoms of fatigue or difficulty breathing on exertion develop. Without treatment, 75 percent of patients with atrial septal defects will die by the age of 50, and 90 percent will die by 60. Surgical closure of the defect is the treatment of choice, an operation that has been performed successfully since the 1950s. In the December 13, 1990 issue of the New England Journal of Medicine, researchers report the results of 30 years of follow-up on the first patients to receive surgical treatment. The results indicated that the survival of patients treated while young was indistinguishable from that of control subjects of the same age. However, the long-term survival of patients who underwent the surgery at an older age was significantly poorer than appropriately age-matched controls. The operation is serious, but is now performed routinely. Since the procedure affords the patient a noticeable improvement in resistance to fatigue and in general well-being, it should be offered to appropriate patients, even those with minimal symptoms. However, newer methods of treatment are under investigation that may further reduce the risk of surgery. These new methods involve the use of a mechanical device that has been likened to a double umbrella. The device may be inserted using a catheter, eliminating the necessity of opening the heart itself. Spring tension then attaches the device to the atrium where it then blocks the defect. While such techniques are still experimental, they may possibly replace surgery as the treatment of choice for atrial septal defects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Heart, Heart surgery, editorial

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Surgical closure of atrial septal defect in adults

Article Abstract:

Surgery appears to be more effective than drugs in the treatment of atrial septal heart defects in adults. Atrial septal defect is an abnormal opening between the chambers of the heart. They are often undiagnosed in the first decades of life, but can significantly reduce life expectancy. Surgical repair of the defects before the age of 25 is considered to prolong life. However, there are conflicting studies on the benefits of performing surgery on patients older than 25. A 1995 study of adults with atrial septal defects found that 10-year survival rates were 95% among surgical patients and 84% among medically treated patients. Heart function improved in 32% of the surgical patients but only 3% of the medically treated patients. However, surgery did not decrease the risk of arrhythmias or blood clotting abnormalities.

Editorial

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Atrial arrhythmia after surgical closure of atrial septal defects in adults

Article Abstract:

People with atrial septal defects should have surgery to close the defect while they are still young adults. Atrial septal defects are openings in the thin wall of tissue that separates the two atria in the heart. This allows blood to flow between the atria, and this can cause serious problems including arrhythmias. Researchers analyzed the rate of arrhythmia in 213 adults who had surgery to close an atrial septal defect. The most common risk factor for arrhythmia was age over 40 years old. Many patients continued to have arrhythmias after surgery.

Risk factors, Atrial fibrillation, Atrial flutter

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