Original Article
A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults
N Engl J Med 1995; 333:469-473August 24, 1995
- Abstract
Background
The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired defects is largely unknown, and the outcome for patients operated on after the fourth decade of life has not yet been compared with that for medically treated patients in a controlled follow-up study.
Methods
In a retrospective study, we examined the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The 84 patients (47 percent) who underwent surgical repair were compared with the 95 patients (53 percent) who were treated medically. The mean (±SD) follow-up period was 8.9±5.2 years (range, 1 to 26).
Results
Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated patients was 95 percent, as compared with 84 percent for the medically treated patients. In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different.
Conclusions
The surgical repair of an atrial septal defect in patients over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to heart failure. However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications.
Media in This Article
Figure 1
Estimated Probability of Survival for 179 Patients with Isolated Atrial Septal Defects.Figure 2
New York Heart Association (NYHA) Functional Class of Patients at the Time of Diagnosis (Gray Bars) and at the End of the Follow-up Period (Black Bars).Article Activity
- Article
Patients with isolated atrial septal defects may have a benign clinical course. Most of them have minimal, if any, functional limitation during childhood and adolescence.1 Patients often survive to an advanced age.2-4 Nevertheless, the life expectancy of patients with unrepaired atrial septal defects is generally thought to be shortened. According to a commonly cited observational report, less than 50 percent of these patients survive beyond the age of 40 years, and only 10 percent reach the age of 60.5 However, the clinical series that formed the basis for this estimate included only small numbers of middle-aged and elderly patients, and these either were examined on only one occasion6 or were followed for a mean period that did not exceed five years.2 Furthermore, although the surgical closure of an atrial septal defect is performed frequently in patients over 40,7,8 there is a lack of controlled follow-up studies comparing the long-term outcome for such patients with that of a medically treated population with unrepaired defects. The data available in the literature cannot be considered sufficient to demonstrate whether surgical closure or medical treatment is preferable for middle-aged and elderly patients with atrial septal defects.9
In the present study, we followed the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The outcome of the 84 patients who were operated on was compared with that of the remaining 95 patients, who were treated medically throughout the follow-up period. The aim of the study was to examine the effect of surgery on long-term survival as well as on the incidence of cardiovascular events during follow-up.
Methods
Study Population
Between November 1966 and July 1991, 179 patients over 40 years of age were given a diagnosis of atrial septal defect at the Universitätsklinik Freiburg or the Herzzentrum Bad Krozingen. There were 125 women (70 percent) and 54 men (30 percent), with a mean (±SD) age of 56±9 years (range, 41 to 79). Of these patients, 3 (2 percent) had ostium primum defects, 13 (7 percent) had sinus venosus defects of the superior vena caval type, and the remaining 163 (91 percent) had ostium secundum defects. All the patients underwent right heart catheterization, and the ratio of pulmonary to systemic blood flow (Qp:Qs) was determined by oximetry. The study patients had predominant left-to-right interatrial shunt with a Qp:Qs of at least 1.5:1. We excluded from the study patients who had been referred for reoperation of previously repaired atrial septal defects (i.e., those repaired before the age of 40), as well as those with complex congenital cardiac malformations. Patients with angiographically confirmed coronary artery disease or severe mitral regurgitation were also excluded.
Treatment of the Atrial Septal Defect
Surgically Treated Patients
Surgical closure of the defect was performed in 84 patients (47 percent). The mean age at the time of operation was 56±7 years. Surgical closure of the defect was combined with repair of partial anomalous pulmonary venous drainage in three patients (4 percent) and tricuspid-valve annuloplasty in four (5 percent). Sixty-seven of the 84 patients (80 percent) were referred for surgery within 12 months of confirmation of the diagnosis by cardiac catheterization. The remaining 17 patients in this group (20 percent) were initially treated medically and underwent surgery after a period ranging from 2 to 16 years (mean, 7±4 years), either at the discretion of the physicians caring for them or because of the initial reluctance of the patients to undergo surgery. A complete clinical and hemodynamic follow-up evaluation, including right and left heart catheterization as well as coronary angiography, was performed in all patients before surgery.
Medically Treated Patients
In our study group, 95 patients (53 percent) were given only medical treatment (digitalis, diuretics, or nitrates), which extended throughout the follow-up period; the decision not to operate was based on the judgment of the cardiologists and cardiac surgeons involved in each case. All patients who were not referred for surgical closure of the defect after diagnosis were advised to appear for follow-up examinations at 12-month intervals or as soon as they noticed the onset of new symptoms or the worsening of existing symptoms.
Follow-up Evaluation
The mean follow-up period was 8.9±5.2 years (range, 1 to 26). The current status of all patients was assessed by means of a standardized questionnaire addressed to the referring physician or by direct telephone contact with the patient or a first-degree relative. Complete clinical data included the patient's New York Heart Association (NYHA) functional class, cardiac rhythm (in particular, atrial fibrillation or flutter), specific cardiac symptoms, current medication, and information on the occurrence of cardiovascular events. A cardiovascular event was defined as death due to cardiovascular causes (congestive heart failure, sudden death, massive pulmonary embolism, or stroke), transient ischemic attack or nonfatal stroke, peripheral arterial embolization, a new instance of atrial fibrillation or flutter (whether sustained or paroxysmal), or the need for implantation of a permanent pacemaker. Postoperative cardiovascular events were further classified as early or late, depending on whether they occurred within 30 days of surgery or after this period. Finally, the progression to congestive heart failure was clinically defined as a change in the patient's NYHA ranking to class III or IV, which reflected either the death of the patient due to heart failure or severe functional limitation at the end of the follow-up period.
Death certificates as well as autopsy reports were obtained for all patients who died. Causes of death were classified as either cardiovascular, according to the above definition, or noncardiovascular. In addition, for patients who underwent surgical repair of the defect, perioperative mortality was defined as death within 30 days after the operation.
Statistical Analysis
In the statistical description of the patients, absolute and relative frequencies were calculated for discrete variables; means (±SD) were determined for continuous variables. Differences between the characteristics of the two patient groups — medical and surgical — were tested for significance with Fisher's exact test, for discrete variables, and with the two-sample Wilcoxon rank-sum test, for continuous variables.10
Overall survival time for all patients started at the date of right heart catheterization. To avoid waiting-time bias, surgically treated patients were counted as belonging to the medically treated group until the date of closure of the defect.11 For the surgically treated patients, survival time free of cardiovascular events started at the date of operation. A Cox proportional-hazards model12 was used to investigate the independent prognostic effect of base-line characteristics on the patients' total and event-free survival. Base-line continuous variables were prospectively dichotomized at clinically relevant cutoff points. The results are presented as estimates of relative risk, with corresponding 95 percent confidence intervals and P values calculated with Wald's test. Because of the high number of cardiovascular events occurring shortly after surgical repair, the corresponding relative risk for surgically treated, as opposed to medically treated, patients is not constant over time and must be interpreted as an average risk during the whole follow-up period. For purposes of graphic presentation, estimates of the probability of overall survival according to treatment group were calculated on the basis of the Cox model.13 Multiple logistic regression was used to investigate the independent effect of base-line characteristics on the functional deterioration of patients, defined as a change in the patient's status to NYHA class III or IV — severe functional limitation or death due to heart failure — by the end of the follow-up period. The results are presented as odds-ratio estimates with corresponding 95 percent confidence intervals and P values calculated with Wald's test.
All tests of significance were two-tailed, with P values of less than 0.05 assumed to indicate significance.
Results
Clinical and Hemodynamic Characteristics at Diagnosis
The symptoms and clinical characteristics of the medically and surgically treated patients at the time of diagnosis are presented in Table 1Table 1
Clinical Characteristics of 179 Consecutive Patients Who Presented with Atrial Septal Defect.. The mean age of the patients who subsequently underwent closure of the defect was 54±7 years, whereas the age of those who were treated medically was 57±10 years (P = 0.01). There was no significant difference between the two groups with regard to other clinical characteristics. Overall, 168 patients in the study population (94 percent) reported cardiac symptoms at presentation.Table 2Table 2
Hemodynamic Characteristics at the Time of Diagnosis. shows the hemodynamic characteristics of the study group at the time of initial cardiac catheterization. Comparison of pulmonary-artery pressures — systolic, diastolic, and mean — revealed no appreciable difference between the medical and surgical groups. Overall, 121 patients (68 percent) had systolic pulmonary-artery pressures of less than 40 mm Hg, 46 patients (26 percent) had systolic pressures of 40 to 60 mm Hg, and 12 patients (7 percent) had severe pulmonary hypertension with systolic pressures exceeding 60 mm Hg. Surgically treated patients had lower values for pulmonary vascular resistance (Table 2). However, markedly elevated pulmonary vascular resistance — defined as a value higher than 400 dyn sec
Multivariate Analysis of Factors Affecting Mortality
Cox proportional-hazards analysis revealed a significant decrease in overall mortality after surgical closure of an atrial septal defect. After adjustment for the covariates listed in Table 3Table 3
Relative Risk of Adverse Outcomes According to Treatment and Clinical and Hemodynamic Characteristics at Diagnosis., the relative risk of death was 0.31 for patients who underwent surgical closure, as compared with the patients treated medically (P = 0.02). The estimated probability of survival was 98 percent at 5 years after catheterization and 95 percent at 10 years for surgically treated patients, as compared with 93 and 84 percent, respectively, for those treated medically (Figure 1Figure 1Estimated Probability of Survival for 179 Patients with Isolated Atrial Septal Defects.). Among the clinical and hemodynamic variables, NYHA class III or IV, a systolic pulmonary pressure of 40 mm Hg or more, and a Qp:Qs ratio of more than 2.5:1 at the time of diagnosis were found to be significant independent predictors of death in the study population (Table 3).There were no perioperative deaths among the patients who underwent surgical closure of the defect. After discharge from the hospital, the 84 patients in this group were followed for a mean of 9.1±5.0 years. Six patients died during the follow-up period. There were three deaths from cardiovascular causes; two of these were due to congestive heart failure. In the third patient, who died suddenly, 24-hour Holter monitoring had indicated the presence of complex ventricular arrhythmias. Two patients died from noncardiovascular causes, one of a metastatic colonic tumor and one of an ovarian tumor. The cause of death of one patient remained unknown.
Medically treated patients were followed for 8.8±5.3 years after diagnosis of the defect. During this period, 23 patients died. Of 21 deaths due to cardiovascular causes in this group, 15 were due to congestive heart failure; 1 was due to massive pulmonary embolism; and 2 were the result of stroke. In the remaining three patients, who died suddenly of unspecified cardiac disease, an arrhythmogenic cause of death was considered probable on the basis of a history of ventricular arrhythmia. One medically treated patient died of an unknown cause and another patient, who had recurrent respiratory infections, died of pneumonia.
Incidence of Cardiovascular Events
Cardiovascular events occurred in nine (11 percent) of the surgically treated patients during the early postoperative phase, two of whom required implantation of a pacemaker (Table 4Table 4
Cardiovascular Events during Follow-up.). After discharge from the hospital, another 25 patients from this group (30 percent) had late complications. Of the nine patients who had a late transient ischemic attack or stroke, six (67 percent) had atrial fibrillation, which was of new (postoperative) onset in two cases. Only two of the six patients with atrial fibrillation were receiving anticoagulant therapy at the time of the event. In the medically treated group cardiovascular complications occurred in 37 (39 percent) of the patients during long-term follow-up (Table 4). Six medically treated patients had a transient ischemic attack or stroke during this period, but only two of these patients had a history of permanent or paroxysmal atrial fibrillation.Multivariate analysis showed no independent favorable effect of surgery on the overall incidence of cardiovascular events during follow-up (Table 3). This finding is explained by the lower average duration of event-free survival in the surgically treated group, which was due to the increased incidence of nonfatal cardiovascular complications in the early postoperative period.
The functional status of the surgically and medically treated patients at presentation and at the end of the follow-up period is presented in Figure 2AFigure 2
New York Heart Association (NYHA) Functional Class of Patients at the Time of Diagnosis (Gray Bars) and at the End of the Follow-up Period (Black Bars). and Figure 2B. Overall, function, as measured by the NYHA scale, improved in 27 of the surgically treated patients (32 percent) and deteriorated in only 9 patients (11 percent). The favorable effect of surgical treatment was most prominent in the subgroup of patients with severe preoperative heart failure (NYHA class III or IV), since 69 percent of those patients had a long-term improvement in NYHA functional class after defect closure.In the medically treated group, a deterioration in NYHA class was observed in 32 of the 95 patients (34 percent); only 3 patients (3 percent) had a long-term lessening of the severity of heart failure with medical treatment. Logistic-regression analysis confirmed that the surgical repair of atrial septal defects resulted in a considerable reduction in the risk of functional deterioration (P = 0.002) (Table 3).
Discussion
The surgical repair of atrial septal defects has been performed for approximately 40 years.15 During this time, several investigators have reported on the clinical course of patients who were operated on after the age of 40.7,8,16-19 However, none of these studies compared the outcome of surgical treatment with that of medical treatment in an age-matched control group with unrepaired defects. In addition, Murphy et al. recently pointed out that patients who undergo surgery after the age of 40 are at increased risk for postoperative cardiovascular complications, whereas surgically treated children and young adults have an excellent prognosis.20 In accord with these findings, we found no favorable effect of operation on the survival of elderly patients with atrial septal defects and concomitant cardiac diseases, such as coronary atherosclerosis or mitral regurgitation.21 In the light of such findings, the traditional recommendation of routine surgical treatment for middle-aged and elderly patients with atrial septal defects and substantial left-to-right shunts7,22 has recently been called into question.9
In our present study the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40 was followed over a mean period of 8.9±5.2 years. Nearly half the patients (47 percent) underwent surgical repair of the defect, whereas the remaining patients received only medical treatment, which extended throughout the follow-up period. Multivariate analysis showed a significant reduction in overall mortality after surgical closure of the defect. For the surgical group as compared with the medically treated group, the relative risk of death during the follow-up period was 0.31. Our results suggest that the surgical repair of atrial septal defects substantially increases the long-term survival of middle-aged and elderly patients. There were no perioperative deaths in our study group, and the estimated 10-year survival rate after surgery was 95 percent, as compared with a rate of 84 percent for medically treated patients.
These results are similar to the excellent survival rates reported by Horvath et al.8 in a group of patients who were younger than our study population and also had less severe symptoms at the time of operation. On the other hand, our findings do not agree with a recent study that found that the closure of an atrial septal defect in adult life does not significantly alter the patient's prognosis.23 However, as noted by its authors, that study included only patients who had minimal, if any, cardiac symptoms at presentation, as well as normal pulmonary-artery pressures. It is therefore not possible to extrapolate those results to an unselected adult population with unrepaired defects.
In contrast to the clear long-term survival benefit of surgical treatment, the incidence of nonfatal cardiovascular complications during the follow-up period was not reduced by surgical closure of the defect. This was mostly a result of the occurrence of early postoperative complications in nine (11 percent) of the patients who underwent surgery. During long-term follow-up, atrial fibrillation or flutter developed in 15 percent of the surgically treated patients, an incidence similar to that observed in the medically treated group (17 percent). Furthermore, paroxysmal or permanent atrial fibrillation was present in the majority of the patients — six of nine — who had a transient ischemic attack or stroke during the late postoperative phase. Thus, our observations are consistent with the conclusions reached by other researchers that the repair of atrial septal defects late in life does not significantly reduce the development of atrial fibrillation or the morbidity associated with thromboembolic complications.20,23
The functional status (NYHA class) of the patients followed in our study improved dramatically after surgical, as compared with medical, treatment of the defect. Of the surgically treated patients, 32 percent reported a long-term reduction in the severity of symptoms related to heart failure, as opposed to only 3 percent of those treated medically. Of even greater clinical importance is the fact that there was functional improvement in 69 percent of the patients who had had severe heart failure (NYHA class III or IV) before surgery.
A limitation of this study is the retrospective, nonrandomized assignment of patients to the two treatment groups. With such an observational design, selection bias cannot be excluded. In the present study, we observed three variables that were unequally distributed between the surgically and medically treated groups: age, pulmonary vascular resistance, and the Qp:Qs ratio. Surgically treated patients were younger and had lower values for pulmonary vascular resistance than those treated medically; on the other hand, the group that underwent surgery had greater left-to-right shunts. When these differences are taken together, they do not indicate a more favorable prognosis for one group over the other. Nevertheless, in order to adjust for the biasing effects of any measured confounding factors, all our analyses were based on multivariate regression models that took into account all important prognostic factors. In addition, patients with either concomitant coronary artery disease or severe mitral regurgitation that required surgical treatment were excluded from the study.
The results of the present study indicate that the surgical repair of atrial septal defects in middle-aged and elderly patients is superior to medical treatment as regards both long-term survival and the lessening of functional limitation due to heart failure. However, the risk of atrial arrhythmia is not reduced by closure of the defect, and surgically treated patients should be followed closely for the onset of atrial fibrillation or flutter in order to prevent or reduce morbidity resulting from cerebral thromboembolism.
We are indebted to Dr. E. Braunwald for a thorough review of the manuscript.
Source Information
From the Abteilung Innere Medizin III–Kardiologie (S.K., A.G., H.J.), Abteilung Herz und Gefässchirurgie (G.S.), and Abteilung Medizinische Biometrie und Informatik (M.O.), Universitätsklinik Freiburg, Freiburg; the Herzzentrum Bad Krozingen, Bad Krozingen (L.G., H.R.); and the St. Josef Hospital, Wiesbaden (W.K.) — all in Germany.
Address reprint requests to Dr. Geibel at the Universitätsklinik Freiburg, Innere Medizin III–Kardiologie, Hugstetter Str. 55, D-79106 Freiburg, Germany.
- References
References
1
Campbell M ,Neill C ,Suzman S . The prognosis of atrial septal defect. BMJ 1957;1:1375-1383
CrossRef | Web of Science | Medline2
Markman P ,Howitt G ,Wade EG . Atrial septal defect in the middle-aged and elderly. Q J Med 1965;34:409-426
Web of Science | Medline3
Rodstein M ,Zeman FD ,Gerber IE . Atrial septal defect in the aged. Circulation 1961;23:665-674
Web of Science | Medline4
Perloff JK . Ostium secundum atrial septal defect -- survival for 87 and 94 years. Am J Cardiol 1984;53:388-389
CrossRef | Web of Science | Medline5
Campbell M . Natural history of atrial septal defect. Br Heart J 1970;32:820-826
CrossRef | Web of Science | Medline6
Craig RJ ,Selzer A . Natural history and prognosis of atrial septal defect. Circulation 1968;37:805-815
Web of Science | Medline7
Magilligan DJ Jr ,Lam CR ,Lewis JW Jr ,Davila JC . Late results of atrial septal defect repair in adults. Arch Surg 1978;113:1245-1247
Web of Science | Medline8
Horvath KA ,Burke RP ,Collins JJ Jr ,Cohn LH . Surgical treatment of atrial septal defect: early and long-term results. J Am Coll Cardiol 1992;20:1156-1159
CrossRef | Web of Science | Medline9
Ward C . Secundum atrial septal defect: routine surgical treatment is not of proven benefit. Br Heart J 1994;71:219-223
CrossRef | Web of Science | Medline10
Bailar JC III, Mosteller F, eds. Medical uses of statistics. 2nd ed. Waltham, Mass.: NEJM Books, 1992:261-9, 281-91.
11
Crowley J ,Hu M . Covariance analysis of heart transplant survival data. J Am Stat Assoc 1977;72:27-36
CrossRef | Web of Science12
Cox DR . Regression models and life-tables. J R Stat Soc [B] 1972;34:187-22013
Makuch RW . Adjusted survival curve estimation using covariates. J Chronic Dis 1982;35:437-443
CrossRef | Medline14
Saksena FB ,Aldridge HE . Atrial septal defect in the older patient: a clinical and hemodynamic study in patients operated on after age 35. Circulation 1970;42:1009-1020
Web of Science | Medline15
Rahimtoola SH ,Kirklin JW ,Burchell HB . Atrial septal defect. Circulation 1968;38:Suppl V:V-216
Fiore AC ,Naunheim KS ,Kessler KA , et al. Surgical closure of atrial septal defect in patients older than 50 years of age. Arch Surg 1988;123:965-967
Web of Science | Medline17
Nasrallah AT ,Hall RJ ,Garcia E ,Leachman RD ,Cooley DA . Surgical repair of atrial septal defect in patients over 60 years of age: long-term results. Circulation 1976;53:329-331
Web of Science | Medline18
St John Sutton MG ,Tajik AJ ,McGoon DC . Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up. Circulation 1981;64:402-409
CrossRef | Web of Science | Medline19
Foster-Smith KW ,Murphy JG ,Bailey KR , et al. Secundum atrial septal defect (ASD): clinical profile and surgical experience in septuagenarians and older. J Am Coll Cardiol1994;465A-465A abstract.
Web of Science20
Murphy JG ,Gersh BJ ,McGoon MD , et al. Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years. N Engl J Med 1990;323:1645-1650
Full Text | Web of Science | Medline21
Konstantinides S ,Geibel A ,Kasper W ,Bubenheimer P ,Gornandt L ,Just H . Atrial septal defect in patients over 40 years of age: effect of surgical repair on the long-term clinical course. Circulation 1994;90:Suppl:I-172 abstract.22
Robb GH . Management of atrial septal defect in middle age. Am Heart J 1973;85:837-838
CrossRef | Web of Science | Medline23
Shah D ,Azhar M ,Oakley CM ,Cleland JGF ,Nihoyannopoulos P . Natural history of secundum atrial septal defect in adults after medical or surgical treatment: historical prospective study. Br Heart J 1994;71:224-228
CrossRef | Web of Science | Medline
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1
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A. Van De Bruaene, R. Buys, L. Vanhees, M. Delcroix, J.-U. Voigt, W. Budts. (2011) Regional right ventricular deformation in patients with open and closed atrial septal defect. European Journal of Echocardiography 12:3, 206-213
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F. Berger, P. Ewert. (2011) Atrial septal defect: waiting for symptoms remains an unsolved medical anachronism. European Heart Journal 32:5, 531-534
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T. Altindag, J.W. Roos-Hesselink, J.A.A.E Cuypers, R. Domburg, P.P.T Jaegere, F.J. Meijboom, M. Witsenburg. (2010) Transcatheter device closure of atrial septal defects in patients aged 40 years and older. Netherlands Heart Journal 18:11, 537-542
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Valérie Steiger Stolt, Massimo Chessa, Pierre Aubry, Jean-Michel Juliard, Rainer Schraeder, Alexandre Berger, Jean-Jacques Goy. (2010) Closure of ostium secundum atrial septum defect with the Atriasept occluder: Early European experience. Catheterization and Cardiovascular InterventionsNA-NA
CrossRef28
Yu-Sheng Lee, Mei-Jy Jeng, Pei-Chen Tsao, Chia-Feng Yang, Wen-Jue Soong, Betau Hwang, Ran-Bin Tang. (2009) Pulmonary function changes in children after transcatheter closure of atrial septal defect. Pediatric Pulmonology 44:10, 1025-1032
CrossRef29
John G. T. Augoustides, E. Andrew Ochroch. (2009) Assessment of Intracardiac Shunts. International Anesthesiology Clinics 46:2, 83-103
CrossRef30
Bret A. Mettler, Benjamin B. Peeler. (2009) Congenital Heart Disease Surgery in the Adult. Surgical Clinics of North America 89:4, 1021-1032
CrossRef31
Alessandro Giardini, Andrea Donti, Francesca Sciarra, Gabriele Bronzetti, Elisabetta Mariucci, Fernando M. Picchio. (2009) Long-term incidence of atrial fibrillation and flutter after transcatheter atrial septal defect closure in adults. International Journal of Cardiology 134:1, 47-51
CrossRef32
Manabu Taniguchi, Teiji Akagi, Shinichi Ohtsuki, Yoshio Okamoto, Yasuharu Tanabe, Nobuhisa Watanabe, Koji Nakagawa, Norihisa Toh, Kengo Kusano, Shunji Sano. (2009) Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation. Catheterization and Cardiovascular Interventions 73:5, 682-686
CrossRef33
U. Thilén, J. Carlson, P.G. Platonov, S.B. Olsson. (2009) Atrial myocardial pathoelectrophysiology in adults with a secundum atrial septal defect is unaffected by closure of the defect. A study using high resolution signal-averaged orthogonal P-wave technique. International Journal of Cardiology 132:3, 364-368
CrossRef34
Qiang Zhao, Xiaoning Sun, Anqing Chen, Limin Xia, Zhe Wang, M.D.. (2009) Endoscopy-Guided Occlusion of Secundum Atrial Defect Permits Use of Smaller, Cosmetically Superior Thoracotomy. Journal of Cardiac Surgery 24:2, 181-184
CrossRef35
Sergey Yalonetsky, Avraham Lorber. (2009) Comparative Changes of Pulmonary Artery Pressure Values and Tricuspid Valve Regurgitation Following Transcatheter Atrial Septal Defect Closure in Adults and the Elderly. Congenital Heart Disease 4:1, 17-20
CrossRef36
Christian Spies, Ziyad M. Hijazi. (2009) Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly. Korean Circulation Journal 39:2, 47
CrossRef37
Carole A. Warnes, Roberta G. Williams, Thomas M. Bashore, John S. Child, Heidi M. Connolly, Joseph A. Dearani, Pedro del Nido, James W. Fasules, Thomas P. Graham, Ziyad M. Hijazi, Sharon A. Hunt, Mary Etta King, Michael J. Landzberg, Pamela D. Miner, Martha J. Radford, Edward P. Walsh, Gary D. Webb. (2008) ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Journal of the American College of Cardiology 52:23, e143-e263
CrossRef38
DHANUNJAYA LAKKIREDDY, UMAMAHESH RANGISETTY, SUBRAMANYA PRASAD, ATUL VERMA, MAZDA BIRIA, LOREN BERENBOM, RHEA PIMENTEL, MARTIN EMERT, THOMAS ROSAMOND, TAMER FAHMY, DIMPI PATEL, LUIGI DI BIASE, ROBERT SCHWEIKERT, DAVID BURKHARDT, ANDREA NATALE. (2008) Intracardiac Echo-Guided Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Atrial Septal Defect or Patent Foramen Ovale Repair: A Feasibility, Safety, and Efficacy Study. Journal of Cardiovascular Electrophysiology 19:11, 1137-1142
CrossRef39
Christian Spies, Abha Khandelwal, Ines Timmermanns, Rainer Schräder. (2008) Incidence of Atrial Fibrillation Following Transcatheter Closure of Atrial Septal Defects in Adults. The American Journal of Cardiology 102:7, 902-906
CrossRef40
Fang Fang, Yat-Yin Lam, Zhi-An Li, Ya Yang, Yat-Sun Chan, Cheuk-Man Yu. (2008) Identification of Unusual Conditions after Atrial Septal Defect Repair by Systematic Transthoracic Echocardiographic Assessment. Echocardiography
CrossRef41
Noriyuki Matsutani, Richard Lee, Jennifer O’Leary. (2008) Thoracoscopic Pulmonary Vein Isolation after Previous Percutaneous Atrial Septal Defect Closure. Journal of Cardiac Surgery
CrossRef42
K. Le Doare, S. Ameli-Renani, D. Banerjee, S. J. D. Brecker, J. B. Eastwood. (2008) Acute renal failure and multiple sites of ischaemia: what is the unifying diagnosis?. NDT Plus 1:5, 359-360
CrossRef43
Giovanni Battista Luciani, Francesca Viscardi, Mara Pilati, Roberto Crepaz, Giuseppe Faggian, Alessandro Mazzucco. (2008) Age at Repair Affects the Very Long-Term Outcome of Sinus Venosus Defect. The Annals of Thoracic Surgery 86:1, 153-159
CrossRef44
Peter Engelfriet, Folkert Meijboom, Eric Boersma, Jan Tijssen, Barbara Mulder. (2008) Repaired and open atrial septal defects type II in adulthood: An epidemiological study of a large European cohort. International Journal of Cardiology 126:3, 379-385
CrossRef45
Felipe Hernández, Julio García-Tejada, Maite Velázquez, Agustín Albarrán, Javier Andreu, Juan Tascón. (2008) Ecocardiografía intracardiaca en el cierre percutáneo de defectos del septo interauricular en adultos. Revista Española de Cardiología 61:5, 465-470
CrossRef46
Andrew W. ElBardissi, Joseph A. Dearani, Rakesh M. Suri, Gordon K. Danielson. (2008) Left-Sided Partial Anomalous Pulmonary Venous Connections. The Annals of Thoracic Surgery 85:3, 1007-1014
CrossRef47
Paul TL Chiam, Howard A Cohen, Carlos E. Ruiz. (2008) The parallel wire technique for septal defect closure. Catheterization and Cardiovascular Interventions 71:4, 564-567
CrossRef48
R. Kharouf, D. M. Luxenberg, O. Khalid, R. Abdulla. (2008) Atrial Septal Defect: Spectrum of Care. Pediatric Cardiology 29:2, 271-280
CrossRef49
Candice K. Silversides, Kym Haberer, Samuel C. Siu, Gary D. Webb, Lee N. Benson, Peter R. McLaughlin, Louise Harris. (2008) Predictors of Atrial Arrhythmias After Device Closure of Secundum Type Atrial Septal Defects in Adults. The American Journal of Cardiology 101:5, 683-687
CrossRef50
Raul I. Rossi, Cristiano de Oliveira Cardoso, Paulo Renato Machado, Lisia Galant Francois, Estela Suzana K. Horowitz, Rogerio Sarmento-Leite. (2008) Transcatheter closure of atrial septal defect with Amplatzer® device in children aged less than 10 years old: Immediate and late follow-up. Catheterization and Cardiovascular Interventions 71:2, 231-236
CrossRef51
LEONHARD BRUCH, ANNE WINKELMANN, STEFFEN SONNTAG, FRANZISKA SCHERF, SASCHA RUX, MARC O. GRAD, FRANZ X. KLEBER. (2008) Fenestrated Occluders for Treatment of ASD in Elderly Patients with Pulmonary Hypertension and/or Right Heart Failure. Journal of Interventional Cardiology 21:1, 44-49
CrossRef52
STEPHAN WINDECKER, BERNHARD MEIER. 2008. Percutaneous closure of patent foramen ovale, atrial septal defects and the left atrial appendage. , 449-468.
CrossRef53
John R. McArdle, Terence K. Trow, Kathryn Lerz. (2007) Pulmonary Hypertension in Older Adults. Clinics in Chest Medicine 28:4, 717-733
CrossRef54
Thomas Walther, Christian Binner, Ardawan Rastan, Ingo Dähnert, Nicolas Doll, Volkmar Falk, Friedrich W. Mohr, Martin Kostelka. (2007) Surgical atrial septal defect closure after interventional occluder placement: Incidence and outcome. The Journal of Thoracic and Cardiovascular Surgery 134:3, 731-737
CrossRef55
Mariëlle Duffels, Laura van Loon, Rolf Berger, Anco Boonstra, Anton Vonk-Noordergraaf, Barbara Mulder. (2007) Pulmonary Arterial Hypertension Associated with a Congenital Heart Defect: Advanced Medium-term Medical Treatment Stabilizes Clinical Condition. Congenital Heart Disease 2:4, 242-249
CrossRef56
Thomas K. Jones, Larry A. Latson, Evan Zahn, Craig E. Fleishman, Joth Jacobson, Robert Vincent, Kirk Kanter. (2007) Results of the U.S. Multicenter Pivotal Study of the HELEX Septal Occluder for Percutaneous Closure of Secundum Atrial Septal Defects. Journal of the American College of Cardiology 49:22, 2215-2221
CrossRef57
Jason B Lindsey, L David Hillis. (2007) Clinical update: atrial septal defect in adults. The Lancet 369:9569, 1244-1246
CrossRef58
Gianfranco Butera, Mariella Lucente, Luca Rosti, Massimo Chessa, Angelo Micheletti, Alessandro Giamberti, Luciane Piazza, Raul Abella, Alessandro Frigiola, Mario Carminati. (2007) A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years. Cardiology in the Young 17:01, 35
CrossRef59
ANGIRA PATEL, KEILA LOPEZ, ANIRBAN BANERJEE, ANNETTE JOSEPH, QI-LING CAO, ZIYAD M. HIJAZI. (2007) Transcatheter Closure of Atrial Septal Defects in Adults ?40 Years of Age: Immediate and Follow-Up Results. Journal of Interventional Cardiology 20:1, 82-88
CrossRef60
George Hayashi, Kenichi Kurosaki, Shigeyuki Echigo, Hideki Kado, Norihide Fukushima, Michio Yokota, Kouichirou Niwa, Tokuko Shinohara, Makoto Nakazawa. (2006) Prevalence of Arrhythmias and Their Risk Factors Mid- and Long-Term After the Arterial Switch Operation. Pediatric Cardiology 27:6, 689-694
CrossRef61
Alessandro Giamberti, Massimo Chessa, Sara Foresti, Raul Abella, Gianfranco Butera, Carlo de Vincentiis, Mario Carminati, Lorenzo Menicanti, Alessandro Frigiola. (2006) Combined Atrial Septal Defect Surgical Closure and Irrigated Radiofrequency Ablation in Adult Patients. The Annals of Thoracic Surgery 82:4, 1327-1331
CrossRef62
W. Kuroczynski, A. Paivandi, D. Wagner, B. Cronen, M. Heinemann, D. Pruefer, Ch.-F. Vahl. (2006) Analyse der chirurgischen Therapie des Vorhofscheidewanddefektes (ASD) bei Adoleszenten und Erwachsenen. Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 20:3, 96-101
CrossRef63
H.-G. Kehl, C. Schmidt, T. D. T. Tjan, H. H. Scheld, H. K. Aken, P. K. Zahn. (2006) Kongenitale Herzvitien im Erwachsenenalter. Intensivmedizin und Notfallmedizin 43:4, 310-330
CrossRef64
Isobel A. Russell, Kathryn Rouine-Rapp, Greg Stratmann, Wanda C. Miller-Hance. (2006) Congenital Heart Disease in the Adult: A Review with Internet-Accessible Transesophageal Echocardiographic Images. Anesthesia & Analgesia 102:3, 694-723
CrossRef65
Martijn C. Post, Maarten J. Suttorp, Wybren Jaarsma, H.W. Thijs Plokker. (2006) Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: A single-center experience. Catheterization and Cardiovascular Interventions 67:3, 438-443
CrossRef66
Joerg S. Sachweh, Sabine H. Daebritz, Benita Hermanns, Bernd Fausten, Stefan Jockenhoevel, Stefan Handt, Bruno J. Messmer. (2006) Hypertensive Pulmonary Vascular Disease in Adults with Secundum or Sinus Venosus Atrial Septal Defect. The Annals of Thoracic Surgery 81:1, 207-213
CrossRef67
Carole A. Warnes. (2005) The Adult With Congenital Heart Disease. Journal of the American College of Cardiology 46:1, 1-8
CrossRef68
Omid Salehian, Eric Horlick, Markus Schwerzmann, Kim Haberer, Peter McLaughlin, Samuel C. Siu, Gary Webb, Judith Therrien. (2005) Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. Journal of the American College of Cardiology 45:4, 499-504
CrossRef69
Thomas Hofmann, Olaf Franzen, Dietmar H. Koschyk, Yskert von Kodolitsch, Britta Goldmann, Thomas Meinertz. (2004) Three-dimensional color Doppler echocardiography for assessing shunt volume in atrial septal defects. Journal of the American Society of Echocardiography 17:11, 1173-1178
CrossRef70
I. F. Purcell, S. J. Brecker, D. E. Ward. (2004) Closure of defects of the atrial septum in adults using the amplatzer device:100 consecutive patients in a single center. Clinical Cardiology 27:9, 509-513
CrossRef71
Andreas Wahl, Stephan Windecker, Bernhard Meier. (2004) Evaluation and treatment of abnormalities of the interatrial septum. Catheterization and Cardiovascular Interventions 63:1, 94-103
CrossRef72
Ellen Thompson, Dennis Moritz, Romaine Perdue, Silvestre Cansino. (2004) Diversion of the Inferior Vena Cava Following Repair of Atrial Septal Defect Causing Hypoxemia. Echocardiography 21:4, 329-332
CrossRef73
Alessandro Giardini, Andrea Donti, Roberto Formigari, Salvatore Specchia, Daniela Prandstraller, Gabriele Bronzetti, Marco Bonvicini, Fernando M Picchio. (2004) Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults. Journal of the American College of Cardiology 43:10, 1886-1891
CrossRef74
Seden Celik, Batuhan Ozay, BahadIr Dagdeviren, Sevket Gorgulu, Aydin Yildirim, Nevzat Uslu, Bülent Ketenci, Mehmet Eren, Haldun Akgoz, Murat Demirtas, Tuna Tezel. (2004) Effect of Patient Age at Surgical Intervention on Long-Term Right Ventricular Performance in Atrial Septal Defect. Japanese Heart Journal 45:2, 265-273
CrossRef75
Ulrike Krumsdorf, Stefan Ostermayer, Kai Billinger, Thomas Trepels, Elisabeth Zadan, Kathrin Horvath, Horst Sievert. (2004) Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. Journal of the American College of Cardiology 43:2, 302-309
CrossRef76
Brack G. Hattler, Tatiana Tsvetkova. (2003) Atrial Septal Defects in the Adult. Primary Care Case Reviews 6:4, 178-184
CrossRef77
Nicolas Doll, Thomas Walther, Volkmar Falk, Christian Binner, Jan Bucerius, Michael A Borger, Jan F Gummert, Friedrich W Mohr, Martin Kostelka. (2003) Secundum ASD closure using a right lateral minithoracotomy: Five-Year experience in 122 patients. The Annals of Thoracic Surgery 75:5, 1527-1530
CrossRef78
Zhong-Dong Du, Ziyad M Hijazi, Charles S Kleinman, Norman H Silverman, Kinley Larntz. (2002) Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults. Journal of the American College of Cardiology 39:11, 1836-1844
CrossRef79
M. TANAKA, C.I. BERUL, M. ISHII, P.Y. JAY, H. WAKIMOTO, P. DOUGLAS, N. YAMASAKI, T. KAWAMOTO, J. GEHRMANN, C.T. MAGUIRE, M. SCHINKE, C.E. SEIDMAN, J.G. SEIDMAN, Y. KURACHI, S. IZUMO. (2002) A Mouse Model of Congenital Heart Disease: Cardiac Arrhythmias and Atrial Septal Defect Caused by Haploinsufficiency of the Cardiac Transcription Factor Csx/Nkx2.5. Cold Spring Harbor Symposia on Quantitative Biology 67:1, 317-326
CrossRef80
Robert M. Steiner, Gautham P. Reddy, Stephanie Flicker. (2002) Congenital Cardiovascular Disease in the Adult Patient. Journal of Thoracic Imaging 17:1, 1-17
CrossRef81
Fause Attie, Martín Rosas, Nuria Granados, Carlos Zabal, Alfonso Buendía, Juan Calderón. (2001) Surgical treatment for secundum atrial septal defects in patients >40 years old. Journal of the American College of Cardiology 38:7, 2035-2042
CrossRef82
Henry W Kort, David T Balzer, Mark C Johnson. (2001) Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique. Journal of the American College of Cardiology 38:5, 1528-1532
CrossRef83
Lucia Torracca, Gennaro Ismeno, Ottavio Alfieri. (2001) Totally endoscopic computer-enhanced atrial septal defect closure in six patients. The Annals of Thoracic Surgery 72:4, 1354-1357
CrossRef84
Susan Fagan, John P. Veinot, Kwan-Leung Chan. (2001) Residual sinus venosus atrial septal defect after surgical closure of atrial septal defect. Journal of the American Society of Echocardiography 14:7, 738-741
CrossRef85
Chi-hang Lee, On-hing Kwok, Katherine Fan, Elaine Chau, Alex Yip, Wing-hing Chow. (2001) Transcatheter closure of atrial septal defect using Amplatzer septal occluder in Chinese adults. Catheterization and Cardiovascular Interventions 53:3, 373-377
CrossRef86
Gruschen R Veldtman, Vanessa Razack, Samuel Siu, Hassan El-Hajj, Fiona Walker, Gary D Webb, Leland N Benson, Peter R McLaughlin. (2001) Right ventricular form and function after percutaneous atrial septal defect device closure. Journal of the American College of Cardiology 37:8, 2108-2113
CrossRef87
KONRAD BROCKMEIER, KLAUS G. SCHMIDT, HERBERT E. ULMER, MATTHIAS GORENFLO. (2001) Occlusion of Interatrial Communications with the Amplatzer Device: Experience in 48 Consecutive Patients. Journal of Interventional Cardiology 14:3, 325-328
CrossRef88
MICHAEL J. LANDZBERG. (2001) Closure of Atrial Septal Defects in Adult Patients: Justification of the "Tipping Point". Journal of Interventional Cardiology 14:2, 267-270
CrossRef89
Marcin Demkow, Witold Ruzyllo, Marek Konka, Cezary Kepka, Miroslaw Kowalski, Janusz Wilczynski, Wanda Rydlewska-Sadowska. (2001) Transvenous closure of moderate and large secundum atrial septal defects in adults using the Amplatzer septal occluder. Catheterization and Cardiovascular Interventions 52:2, 188-193
CrossRef90
R GRAHAM, J GELMAN. (2001) Echocardiographic aspects of percutaneous atrial septal defect closure in adults. Heart, Lung and Circulation 10:2, 75-78
CrossRef91
ANTON MORITZ, MIRKO DOSS, SELAMI DOGAN, TAYFUN AYBEK, GERHARD WIMMER-GREINECKER. (2000) Interventional Versus Surgical Closure of Atrial and Ventricular Septal Defects: Advantages and Limitations of the Catheter-Based Approach. Journal of Interventional Cardiology 13:6, 503-506
CrossRef92
FOLKERT J. MEIJBOOM, MAARTEN WITSENBURG. (2000) The Role of Transesophageal Echocardiography During Catheter Closure of ASD and VSD. Journal of Interventional Cardiology 13:6, 487-492
CrossRef93
Habib A. Dakik, Samir Arnaout, Maurice Khoury, Mounir Obeid. (2000) Cox-maze procedure for treatment of atrial flutter associated with an atrial septal defect. Clinical Cardiology 23:7, 548-549
CrossRef94
J COOKE, J GELMAN, S MENAHEM, R HARPER. (2000) Thrombus on an ASD closure device: A call for caution. Heart, Lung and Circulation 9:1, 30-31
CrossRef95
ALISON CALVER, KEITH DAWKINS, ANTHONY SALMON. (2000) Combined Percutaneous Management of an Atrial Septal Defect and Coronary Artery Disease. Journal of Interventional Cardiology 13:1, 35-37
CrossRef96
Brickner, M. Elizabeth, Hillis, L. David, Lange, Richard A., . (2000) Congenital Heart Disease in Adults. New England Journal of Medicine 342:4, 256-263
Full Text97
U. Thilén, S. Berlind, E. Varnauska. (2000) Atrial Septal Defect in Adults: Thirty-eight-year Follow-up of a Surgically and a Conservatively Managed Group. Scandinavian Cardiovascular Journal 34:1, 79-83
CrossRef98
William E. Hopkins. (1999) Atrial septal defect. Current Treatment Options in Cardiovascular Medicine 1:4, 301-310
CrossRef99
Felix Berger, Michael Vogel, Vladimir Alexi-Meskishvili, Peter E. Lange. (1999) Comparison of results and complications of surgical and amplatzer device closure of atrial septal defects. The Journal of Thoracic and Cardiovascular Surgery 118:4, 674-680
CrossRef100
Felix Berger, Peter Ewert, Per G. Boöjrnstad, Ingo Dähnert, Gregor Krings, Ira Brilla-Austenat, Michael Vogel, Peter E. Lange. (1999) Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder. Cardiology in the Young 9:05,
CrossRef101
Felix Berger, Michael Vogel, Andrea Kramer, Vladimir Alexi-Meskishvili, Yugo Weng, Peter E Lange, Roland Hetzer. (1999) Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. The Annals of Thoracic Surgery 68:1, 75-78
CrossRef102
Gatzoulis, Michael A., Freeman, Marc A.Siu, Samuel C., Webb, Gary D., Harris, Louise, . (1999) Atrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults. New England Journal of Medicine 340:11, 839-846
Full Text103
Michael A Gatzoulis, Sloane Hechter, Gary D Webb, William G Williams. (1999) Surgery for partial atrioventricular septal defect in the adult. The Annals of Thoracic Surgery 67:2, 504-510
CrossRef104
Ameli E. Trantina, Heinrich Machler, Alexander Kulier, Peter Bergmann, Drago Dacar, Helmut Muller, Peter Oberwalder, Gerald Zenker, Bruno Rigler. (1998) Preoperative Prostaglandin E1 Therapy in a Patient with Atrial Septal Defect and Predominant Right-to-Left Shunting. Anesthesia & Analgesia 86:4, 703-705
CrossRef105
K. -F. Lindenau, M. Torka, A. Schneider, R. W. Hacker. (1997) Operative Behandlung angeborener Herzfehler im Erwachsenenalter. Zeitschrift für Herz-, Thorax- und Gefäßchirurgie 11:6, 263-269
CrossRef106
Uwe Helber, Reinhard Baumann, Hartwig Seboldt, Ulrich Reinhard, Hans Martin Hoffmeister. (1997) Atrial Septal Defect in Adults: Cardiopulmonary Exercise Capacity Before and 4 Months and 10 Years After Defect Closure. Journal of the American College of Cardiology 29:6, 1345-1350
CrossRef107
Yoshiki Shibata, Tadaaki Abe, Ryosei Kuribayashi, Satoshi Sekine, Keiji Seki, Itsuro Yamagishi, Jyotirmay Chanda. (1996) Surgical treatment of isolated secundum atrial septal defect in patients more than 50 years old. The Annals of Thoracic Surgery 62:4, 1096-1099
CrossRef108
(1996) Atrial Septal Defect. New England Journal of Medicine 334:1, 56-57
Full Text109
Perloff, Joseph K., . (1995) Surgical Closure of Atrial Septal Defect in Adults. New England Journal of Medicine 333:8, 513-514
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