Long-term follow-up of children after repair of atrial septal defects

Long-term Outcome after Surgical Closure of Atrial Septal Defect in Childhood with Extensive Assessment Including MRI Measurement of the Ventricles

“…Moreover, studies of long-term morbidity have shown better results for surgical closure in childhood as compared with closure in adults [8,[13][14][15][16][17]22]. Therefore, it is generally accepted that an ASD with a hemodynamically relevant left-to-right shunt needs to be closed during childhood.…”

“…Findings related to long-term morbidity were mainly based on questionnaires and interviews [13,16,17]. Only a few studies have evaluated consecutive patient series after operation in childhood and assessed the clinical sequelae during long-term follow-up, and only Meijboom et al and RoosHesselink et al included bicycle ergometry and 24-hour electrocardiograms (ECG) in their studies [14,22].…”

Per-Catheter ASD Closure

“…Adverse consequences improved by ASD closure include elimination of the leftto-right shunt with resultant reduction in total cardiac work and pulmonary blood flow to normal, reduction in volume loading of the right atrium and right ventricle with possible reduction in associated arrhythmias, and elimination of a pathway for paradoxical embolization. Surgical procedures to close atrial septal defects are successful in achieving complete elimination of the unwanted hole in the vast majority of patients, but are not without a small but definite risk of mortality or significant morbidity (such as sepsis, renal failure, pericardial effusion, pneumonia, and pleural effusion) [9,24,25]. Surgical closure even before adulthood has not guaranteed that the heart will return to normal size or that arrhythmias will not be a significant problem in followup [24,25].…”

“…Surgical procedures to close atrial septal defects are successful in achieving complete elimination of the unwanted hole in the vast majority of patients, but are not without a small but definite risk of mortality or significant morbidity (such as sepsis, renal failure, pericardial effusion, pneumonia, and pleural effusion) [9,24,25]. Surgical closure even before adulthood has not guaranteed that the heart will return to normal size or that arrhythmias will not be a significant problem in followup [24,25]. The effect of an atriotomy and cardiopulmonary bypass using modern techniques on atrial electrophysiologic abnormalities is uncertain, but older techniques were clearly associated with instances of sinus node dysfunction and other abnormalities.…”