Comparative very long-term outcome after repair of sinus venosus and ostium secundum atrial septal defects: a 30-year clinical and echocardiographic follow-up

  • Dr Mara Pilati, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Elisabetta Zorzi, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Francesca Viscardi, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Dr Maria Antonia Prioli, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Luca Barozzi, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Prof Corrado Vassanelli, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Prof Alessandro Mazzucco, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Prof Giovanni Battista Luciani, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy

    • Objective. To define prognosis after repair of secundum (ASD) and sinus venosus (SVD) atrial septal defects very long-term outcome was compared.
    Methods. Between 1975-2007, 271 consecutive patients underwent repair of large (>1.0 cm) atrial level defect . All patients underwent clinical and echocardiographic examination. End-points were survival, freedom from cardiovascular events, arrhythmias, cardiac failure, permanent pacing.
    Results. One-hundred patients had repair of SVD and 171 of ASD. Mean age (29±22 vs 26±21 years, p=ns) at surgery and follow-up duration (15±9 vs 14±8 years, p=ns) were comparable, female sex less prevalent in SVD (52% vs 67%, p=0.04). There were 9 deaths (4 cardiac) among SVD and 13 (4 cardiac) among ASD. Thirty-year survival (80±7% vs. 85±4%, p=ns) and freedom from cardiac death were comparable (91±4% vs. 95±2%, p=ns). Prevalence of SVT was similar (26%, SVD, vs. 18%, ASD, p=ns), but permanent atrial fibrillation was significantly more common in SVD (14% vs. 1%, p=0.005). Need for permanent pacing and hospitalization for heart failure were similar, but chronic cardiac medication (33% vs. 19%, p=0.01) and warfarin therapy (15% vs 7%, p=0.04) were more prevalent among SVD patients. At follow-up echocardiography, right heart dilation (30% vs. 10%, p=0.01) and pulmonary hypertension (19% vs 10%, p=0.04) were more common and severe among SVD patients.
    Conclusions. Very late prognosis after atrial septal defects repair is generally satisfactory, although dissimilar for SVD and ASD patients. Higher prevalence of pulmonary hypertension and right heart dilation in SVD may sustain chronic atrial fibrillation and need for cardiac medication.