Clinical Features and Long-Term Clinical Outcomes of Adult Atrial Septal Defects

Kim, Kye Hun; Park, Jong Chun; Lee, Seok; Hong, Seo Na; Lee, Sang Rok; Sohn, Il Suk; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Kim, Weon; Ahn, Youngkeun; Jeong, Myung Ho; Cho, Jeong Gwan; Ahn, Byung Hee; Kim, Sang Hyung; Kang, Jung Chaee

Abstract

BACKGROUND AND OBJECTIVES
: The aim of this study was to investigate the clinical features and long-term outcomes of atrial septal defect (ASD) that presents in adulthood, according to the treatment modalities.
SUBJECTS AND METHODS
: A total of 134 patients (mean age: 42.7+/-17.7 years, 79 females) with ASD were divided into two groups: group I (the surgical treatment group; 100 patients, mean age: 38.3+/-14.7 years, 65 females) and group II (the medical treatment group; 34 patients, mean age: 55.9+/-19.3 years, 14 females). The clinical characteristics at presentation and the long-term clinical outcomes were analyzed between the groups.
RESULTS
: The clinical symptoms at presentation were usually mild. Most of the patients had sinus rhythm except for 14 patients (10.4%) who had atrial fibrillation. The defect size, the systolic pulmonary artery pressure (SPAP) and the pulmonary to systemic flow ratio (Qp/Qs) according to echocardiography were 1.8+/-0.8 cm, 41.1+/-14.2 mmHg and 2.7+/-1.4 respectively. The age at presentation showed a significant positive correlation with the New York Heart Association (NYHA) class (r=0.44), the degree of tricuspid regurgitation (TR)(r=0.31), and the severity of pulmonary hypertension (r=0.45). Group I showed an improved NYHA class (from 1.9+/-0.7 to 1.4+/-0.6, respectively, p<0.001), a decreased SPAP (from 39.3+/-12.7 to 27.5+/-6.6 mmHg, respectively, p<0.001) and a decreased degree of TR (from 1.4+/-0.8 to 0.6+/-0.6, respectively, p<0.001) during the follow-up period. However, group II showed no significant changes. The incidence of hospitalization (10.1% in group I and 32.4% in group II, p=0.005) or arrhythmia (17.2% in group I and 35.3% in group II, p=0.011) was more frequent, and the NYHA functional class (1.4+/-0.6 in group I and 2.2+/-0.9 in group II, p<0.001) was more severe in group II than in group I. The mortality rate was higher in group II than in group I (3 patients: 8.8% in group II, 1 patient and 1.0% in group I, p=0.02) by uni-variate analysis. However, bon the multi-variate analysis, the mortality rate was not different between the groups (p=0.48).
CONCLUSION
: ASD presenting in adulthood showed mild clinical symptoms and a good prognosis. Surgical treatment showed symptomatic improvement, but there was no mortality benefit as compared with medical treatment.