Operative treatment of atrial septal defect: clinical and haemodynamic assessments in 175 patients.

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Abstract
The results of operative treatment were assessed in 175 patients with atrial septal defects; 150 had defects of the septum secundumtype, and 25 had sinus venosus defects with partial anomalous pulmonary venous connection. Forty-one patients were younger than 13 years, 37 older than 40; 150 patients were symptomatic, and 29 were under treatment for heart failure. Cardiac catheterization was performed in every patient before operation, and left-to-right shunts resulting in pulmonary to systemic flow ratios of 1.2/1.0 to 6.0/1.0 were demonstrated. Right-to-left shunts were present in 40 patients. The right ventricular systolic pressure was abnormally high ( > 30 mm Hg) in 101 patients, and it was 50 mm Hg or greater in 30. During cardiopulmonary bypass, 129 secundum defects were closed with prostheses, 21 by direct suture; prostheses which partitioned the atrium and cava and diverted the return from the anamalous pulmonary veins were utilized in all sinus venosus defects. Perforated intracardiac prostheses were employed in 5 patients with extreme pulmonary hypertension and bidirectional shunts; all survived. Six of the 175 patients (3.4%) died at or following operation, and significant but not fatal complications occurred in 88 patients. Detailed post-operative clinical and hemodynamic evaluations were performed in 154 surviving patients; 135 are asymptomatic, 18 improved, and 1 patient worse as the result of cardiomyopathy. Complete abolition of circulatory shunts was proved at post-operative cardiac catheterization in 93% (137/148) of patients in whom complete closure was attempted. in no patient has a residual shunt necessitated further operation. Of 30 patients with right ventricular systolic pressure greater than 50 mm Hg before operation, 23 were recatheterized; 7 have normal pressures, while in 16 the right ventricular pressure was reduced but still abnormal.