Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years

Article Abstract:

Defects in the septum separating the left and right atria of the heart drastically alter the hemodynamics of the heart. The results can be volume overload on the right side of the heart, increased pulmonary resistance, and pulmonary artery hypertension (high blood pressure). The condition is usually asymptomatic in childhood and becomes more serious as the patient matures; 75 percent of patients will die before 50 if the condition remains uncorrected. Atrial septal defects, the third most common form of congenital heart disorder, have been surgically correctable for over 30 years, but there has been little documented follow-up on the earliest patients. For this reason, the cases of 123 patients who underwent surgical correction between 1956 and 1960 were reviewed. The overall 30-year survival of these patients was 74 percent, compared with 85 percent of control subjects who were matched for age and sex. Three patients died in the period immediately following the operation. A major determinant of survival was found to be the age at which the operation was performed. When the operation was performed on patients 11 years or younger, or from 12 to 14, the survival rates were 97 and 93 percent, respectively, which was the same as the controls. Older patients fared less well; patients between 25 and 41 years had a survival rate of 84 percent compared with 91 percent for the controls; patients over 41 when surgery was performed had a survival rate of 40 percent compared with a survival rate for the age-matched controls of 59 percent. Another significant prognostic factor for survival was the systolic pressure in main pulmonary artery prior to the operation. Increased pressure in the main pulmonary artery was associated with decreased survival, and this effect was strongest among the older patients. The researchers also noted an increase in cardiac events later in life among the patients who were older at the time of surgery. Cardiac events, such as heart attack and stroke, will always be more frequent among older patients, but the low frequency of such events among the younger patients is remarkable in that it demonstrates the success of the operation in providing long-term survival and sustained health to these people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Heart, Congenital heart disease, Congenital heart defects, Heart surgery, Atrial septal defects, Atrial septal defects in children

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Adults with tetralogy of Fallot - repaired, yes; cured, no

Article Abstract:

Tetralogy of Fallot is a combination of four different birth defects that affect the heart. Although this type of lesion can be repaired successfully during childhood, patients usually face challenges throughout their lives. A research study found that the 32-year survival rate was 86% for patients who had complete surgical repair of tetralogy of Fallot between 1955 and 1960. All the patients included in the study had survived the immediate post-operative period. The 32-year survival rate of the patients was slightly lower than that of the general population. Repair of tetralogy of Fallot during infancy increases the chances of survival and reduces the risk of complications later in life. A significant number of patients still have problems that require medical or surgical treatment. The most serious types of problems may be those that affect the rhythm or electrical properties of the heart. Patients may also develop psychological problems. The transition from adolescence to adulthood may be particularly difficult.

Editorial, Children, Pediatric surgery

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Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot

Article Abstract:

The long-term survival of patients who have had surgical repair of tetralogy of Fallot may be slightly lower than that of the general population. Tetralogy of Fallot is a combination of four different birth defects that affect the heart. Researchers examined the long-term survival of 163 patients who survived 30 days or until discharge from the hospital after complete surgical repair of tetralogy of Fallot. The estimated 32-year survival rate of the patients was 86%, compared with an expected survival rate of 96%. The estimated 30-year survival rate was slightly lower than expected among patients younger than 12 years and significantly lower than expected for patients older than 12. Ten patients in the study died from late sudden death over a 32-year follow-up period.

Patient outcomes, Mortality, Causes of, Sudden death

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