Murat DEMİRTAŞ, Batuhan ÖZAY, Murat SARGIN, Seden ÇELİK, Bülend KETENCİ, Serdar ÇİMEN, Okan YÜCEL, Önder TESKİN

Yetişkin ASD'li hastalar opere edilmeli mi? Orta ve uzun dönem sonuçları

Amaç: Atriyal septal defekt konjenital kalp hastalıkları arasında en sık görülen anomalilerden biridir. Erişkin hastalarda ise atriyal septal defekt en sık görülen konjenital kalp hastalığıdır ve bu hastalara tedavi yaklaşımı halen bazı tartışmalara konu olmaktadır. Bu çalışmanın amacı atriyal septal defektli erişkin hastaların operasyon sonuçlarını değerlendirmektir. Materyal ve Method: Otuziki erişkin hasta ortalama 5 yıl izlenerek klinik ve laboratuvar bulguları kaydedilip 40 yaş öncesi 45 hasta ile kıyaslandı.Bulgular: Erişkin hasta grubunda fonksiyonel kapasite düzelmesi istatiksel olarak oldukça anlamlı bulundu. Önemli ritm değişiklikleri tespit edilmedi. Bu hasta grubunda ventrikül çapları hariç ekokardiyografik olarak tespit edilen parametrelerde 45 yaş öncesi gruba göre farklılık tespit edilmedi. Tek başına fonksiyonel kapasitenin düzelmesi bile hastaların hayat standartında oldukça iyileşme sağladı.Sonuç: Genç yaş grubuna göre mortalite ve morbiditenin yüksek olmaması erişkin hastaların opere edilmeleri yönünde bizleri cesaretlendirmiştir.

Should adult atrial septal defect cases be operated? Mid and late term results

Background: Atrial septal defect is one of the most commonly seen congenital cases. In adulthood atrial septal defect is the most common congenital cardiac disease.The treatment approach to adult atrial septal defect cases is still debatable.The aim was to evaluate our results of adult atrial septal defect cases treated surgically. Methods: A comparison between 32 patients over 40 years and 45 patients under 40 years old was made after a 5 years follow up.Results: Improvement in functional capacity was significant in adult Atrial septal defect cases. No significant changes in rhytm were seen. Any significant difference of echocardiographic parameters other than ventricular diameters was not found between groups.The improvement in functional capacity increased the life quality of the patients.Conclusions: Morbidity and mortality was also not higher than that is in younger age group which may encourage us to operate the adult atrial septal defect cases.

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1.Miyaji J, Furuse A, Tanaka O, Ono M, Kawauchi M. Surgical repair for atrial septal defect in patients over 70 years of age. Jpn Heart J 1997;38:677-84.
2.Dalen JE, Haynes FW, Dexter L. Life expentancy with atrial septal defect. JAMA 1967;200:442-6.
3.Harjula A, Kupari M, Kyosola K, et al. Early and late results of surgery for atrial septal defect in patients aged over 60 years. J Cardiovasc Surg (Torino) 1988;29:134-9.
4.Berger F, Vogel M, Kramer A, et al. Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 2000;69:981.
5.Vogel M, Berger F, Kramer A, Alexi-Meskishvili V, Lange PE. Diagnosis and surgical treatment of atrial septal defects in adults. Dtsch Med Wochenschr 1999; 124:35-8.
6.Nagao K, Tsuchihashi K, Tanaka S, Iimura O. Studies on atrial arrhythmias in atrial septal defect. The influences of aging on atrial fibrillation. Nippon Ronen Igakkai Zasshi 1995;32:27-32.
7.Nasrallah AT, Hall RJ, Garcia E, Leachman RD, Cooley DA. Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results. Circulation 1976;53:329-31.
8.Fiore AC, Naunheim KS, Kessler KA, et al. Surgival closure of atrial septal defect in patients older than 50 years of age. Arch Surg 1988; 123:965-7.
9.Shibata Y, Abe T, Kuribayashi R, et al. Surgical treatment of isolated secundum septal defect in patients more than 50 years old. Ann Thorac Surg 1996;62:1096-9.
10.Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999;340:839-46.
11.Brandenburg RO Jr, Holmes DR Jr, Brandenburg RO, McGoon DC. Clinical follow-up study of paroxysmal supraventricular tachyarrhythmias after operative repair of a secundum type atrial septal defect in adults. Am J Cardiol 1983;51:273-6.
12.Oliver JM, Gallego P, Gonzalez A, Benito F, Mesa JM, Sobrino JA. Predisposing conditions for atrial fibrillation in atrial septal defect with and without operative closure. Am J Cardiol 2002;89:39-43.
13.Magilligan DJ Jr, Lam CR, Lewis JW Jr, Davila JC. Late results of atrial septal defect repair in adults. Arch Surg, 1978;113:1245-7.
14.Donti A, Bonvicini M, Placci A, et al. Surgical treatment of secundum atrial septal defect in patients older than 50 years. Ital Heart J 2001;2:433-4.
15.Rodstein M, Zeman FD, Gerber IE. Atrial septal defect in the aged. Circulation 1961;23:665-74.
16.Ellis FH, Brandenburg RO, Swan HJC. Defect of atrial septum in the elderly. N Engl J Med 1960;262:219-24.
17.Kobayashi Y, Nakanishi N, Kosakai Y. Pre-and Postoperative Exercise Capacity Associated With Hemodynamics in Adult Patient With Atrial Septal Defect:A Retrospective Study. Eur J Cardiothorac Surg 1997;11:1062-6.
18.Landi F, Cipriani L, Cocchi A, Zuccala G, Carbonin P. Ostium Secundum Atrial Septal Defect in the Elderly. J Am GeriatrSocl991;39:60-3.
19.Thilen U, Berlind S, Vamauskas E. Atrial Septal Defect in Adults. Thirty-eight-year Follow- up of a surgically and a Conservatively Managed Grup. Scand Cardiovasc J 2000;34:79-83.
20.Horvath KA, Burke P, Collins JJ, Cohn LH. Surgical Treatment of Adult Atrial Septal Defect: Early and Long term Results. J Am Coll Cardiol 1992;20:1156-9.
21.Konstantinides S, Geibel A, Kasper W, Just H. The Natural Course of Atrial Septal Defect in Adults- A Still Unsettled Issue. Klin Wochenschr 1991 ;69:506-10.
22.Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J. Surgical treatment for secundum atrial septal defects in patients > 40 years old. A randomized clinical trial. J Am Coll Cardiol 2001 ;38:2035-42.
23.Konstantinides S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1996;334:57.