Surgical Treatment For Over 12 Years Old Patients With Secundum Atrail Septal Defect

Background and Objective:When to treat the adult patients with atrial septal defect is controversial. Many heart centers suggest that adult patients should be treated if they were diagnosed as atrial septal defect.But the evidence to support that view is not enough.This study retrospectively analyzed the geometry changes of heart after surgery and clinical data of over 12 years old patients with atrial septal defect to seek the best time to treat them.Methods:469 over 12 years age patients,who were diagnosed as ostium secundum atrail septal defect in the Cardiovascular Disease Research Institute of Yunnan during January 2012 to September 2014, were chosen as our participants. They were divided into 6 study groups according to their ages (Group A:age 12-20; Group B:age 21-30, Group C:age 31-40, Group D:age 41-50, Group E:age 51-60, Group F:age>60). We collected the clinical histories, examination reports and surgical related data of them,and statistical analyze.Result:The statistical analysis showed that incidence of preoperative circulatory system and arrhythmia is higher in the elderly groups (P<0.05).The average preoperative cardiothoracic ratio, pulmonary artery pressure, right ventricular end-diastole diameter, right atrial diameter, right ventricular outflow tract diameter and left atrial diameter is bigger in the elderly groups than the younger groups.The arterial oxygen saturation in elderly groups were lower (P<0.05).72 hours after surgery in each group, right ventricular end-diastole diameter, right ventricular outflow tract diameter, and right atrial diameter were decreased compared with the preoperation, and further reduced after 3 months (P<0.05).72 hours after operation, the left atrial diameter of all patients were significantly decreased compared with preoperation, but they were slightly widen again after 3 months(P<0.05). The left ventricular end-diastole diameter of each group were widen in 72 hours and 3 month after surgery (P<0.05). The surgical blood loss, postoperative drainage,length of CICU stay and hospital stays of elderly patients who were underwent median sternotomy atrial septal defect repaire were increased (P<0.05).But the duration of surgery, aortic cross-clamp time, CPB time were no significant difference (P>0.05)Conclusions:With age, incidence of circulatory system symptom and arrhythmia, cardiothoracic ratio, pulmonary artery pressure of patients with secundum atrial septal defect were increased, arterial oxygen saturation were decreased. The geometry of heart have changed after surgery in all patients.The surgical blood loss, postoperative drainage, ICU stay time and hospital stays of elderly patients, who were underwent median sternotomy atrial septal defect repaire, were increased or extended than the younger patients.We suggest patients with atrial septal defect should be treated before 40. Old age is not a contraindication for surgery.When patients were older than 40, surgery will be safe if pulmonary vascular resistance<10 wood and arterial oxygen saturation state> 93% without oxygen.