Abnormal left heart function after operation for atrial septal defect.

Abstract

Post-operative data have been presented in seven patients with atrial septal defect. In five of them, residual patency of the atrial septum was found at cardiac catheterization, but in two the defect had been closed. All showed evidence of 'left-sided dysfunction', expressed either as an increase in the pulmonary arterial wedge pressure or the left ventricular end-diastolic pressure or both. The reasons for these findings are not clear, though in several there were indications of impaired right ventricular compliance and possible transmission of raised right-sided pressures to the left side of the heart through a still patent atrial septum. This could not, however, be the mechanism in all cases, and dysfunction of the left ventricle has been seen in two patients in whom the defect was securely closed. The cause of this phenomenon in these selected cases remains obscure.

Hemodynamic Findings before and after Surgery for Atrial Septal Defect of the Secundum Type in Middle-Aged Patients

“…All of them were asymptomatic. Their findings did not correlate with age in patients operated on after 11 years of age, contrary to the findings of Petersson [26], The causes of the impairment in cardiac performance after closure of ASD II are presumably sequelae to the longstanding hemo dynamic stress upon the right ventricle, and in some cases an additional impaired left ventricular function [11,13,16,37]. The basic abnormality might be due to a defective contractile response, and abnormal compli ance characteristics of the ventricular myocardium or a combination of the two.…”

Risk factors for prolonged intensive care treatment following atrial septal defect closure in adults

“…Immediate abnormal left heart function after surgical closure of ASD has first been described as early as in 1971 by Davis et al [4]. The authors reported on 7 patients, who exhibited an increase in the pulmonary artery wedge pressure or left ventricular end-diastolic pressure or both.…”

“…Immediate postoperative or postinterventional left heart failure was mostly reported in the elderly patient [4][5][6][7]. In the present cohort, older patients needed significantly more inotropic support postoperatively.…”

“…However, in adult patients, some cases of severe left ventricular dysfunction after surgical [4,5], or transcatheter ASD closure were observed [6,7]. The reduced left ventricular compliance [8] as a consequence of the chronic volume unloading due to the left-to-right shunt [9], and the inability of the left ventricle to cope with the increased blood flow after ASD closure, was presumed to be the mechanism for the development of left ventricular failure.…”

Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt

“…It is reported that surgical closure of atrial septal defect (ASD) leading to acute left heart failure may occasionally require partial re-opening [1,2]. The characteristics of patients with worsening conditions were hypoplasia of the left ventricle and/or pulmonary artery hypertension (PAH) [1].…”