Surgical management and long term postoperative follow-up of atrial septal defects in adults

The aim is to report an Ivorian experience of the surgical management of atrial septal defects in adulthood. Our retrospective study included 19 patients over 18 years old operated on for atrial septal defects (ASD) between January 2005 and December 2015 at the Abidjan Heart Institute (AHI). 13 women and 6 men with a mean age of 26±9.07 years were included. For each patient we noted the clinical and para-clinical signs as well as the operative result and the short and long term follow-up data. Patients were symptomatic in 73.7% of cases. Two patients had atrial flutter. On cardiac echo-Doppler, the right ventricle measured 43.5 ±4.2 mm. The systolic pulmonary artery pressure was 45 ± 14.7 mmHg. There were 3 cases of grade III tricuspid insufficiency and 1 case of abnormal venous return. Closure of the septal defect was performed with an autologous pericardial patch in 18 cases. Operative mortality was nil. The average length of stay in the surgical intensive care unit was 2.5 days. Eleven patients presented immediate postoperative complications, including 2 cardiac and 9 extracardiac. The total postoperative hospital stay was 14.7 days. After a mean follow-up of 8.25 ± 4 years, all patients had functional improvement with a significant decrease in right ventricular size and pulmonary arterial pressure. Surgical management of atrial septal defects in adulthood is associated with low mortality with a satisfactory functional outcome.