Heart failure in atrial septal defect

Atrial Septal Defect in Patients over the Age of Forty Years

“…6,9,15 Thus, in the present study, 92% of patients had significant symptoms, and 45% were severely limited. This finding is in sharp contrast to the infrequent occurrence of disability in younger patients with ASD.A 10,21 Although objective evidences of cardiac dysfunction such as cardiac enlargement, atrial fibrillation, and congestive heart failure, have been recognized relatively more frequently in elderly patients with ASD,'1 3, 5, 6, 9, 10 the hemodynamic alterations that accompany and may be responsible for the development of symptoms and objective evidence of impaired cardiac function have not been clearly delineated previously.…”

“…This finding is in sharp contrast to the infrequent occurrence of disability in younger patients with ASD.A 10,21 Although objective evidences of cardiac dysfunction such as cardiac enlargement, atrial fibrillation, and congestive heart failure, have been recognized relatively more frequently in elderly patients with ASD,'1 3, 5, 6, 9, 10 the hemodynamic alterations that accompany and may be responsible for the development of symptoms and objective evidence of impaired cardiac function have not been clearly delineated previously. Thus, while PA hypertension has been noted with a greater frequency in older patients with ASD than in those under 40 years of age,4 6,8,10 there is only limited evidence suggesting that incapacitated patients more frequently have PA hypertension.6 It has also been considered that left ventricular dysfunction, pulmonary infections or repeated pulmonary emboli may contribute to the appearance and progression of symptoms.3 6,9,10 In the present study a clear relation between the existence of PA hypertension and the degree of symptomatic limitation was apparent. Eighty-two per cent of the patients in functional classes III and IV had PA hypertension (average PA systolic pressure, 59 mm Hg), and in 50% of this group the PA hypertension was classified as severe.…”

“…Despite the high incidence of PA hypertension, patients with balanced or predominantly right-to-left shunting represent a relatively small fraction of older patients with ASD,1 6,9,10 congestive heart failure. The relation between specific clinical and hemodynamic factors and operative mortality in these patients is difficult to assess, not only because of the relatively low operative mortality, but also because the majority of deaths occurred in the early surgical experience with this lesion.…”

Hemodynamic Findings before and after Surgery for Atrial Septal Defect of the Secundum Type in Middle-Aged Patients

“…It occurs with an increasing frequency from the third decade of life, and it often precedes congestive heart failure by a year or two [6], In the present series, the RAMP and PCV (or LA) MP were significantly higher in pa tients with atrial fibrillation than in those with sinus rhythm. These high atrial pressures presumably reflect left ventricular failure, as emphasized by Dexter [13], and T ikoff et al [37]. In the present study most of the left atrial pressures were estimated from the PCV pressure, and some dis crepancies may exist between these two pressures [38].…”

The mechanism of abnormal septal motion in atrial septal defect: pre- and postoperative study by radionuclide ventriculography in adults.

“…Postoperatively, mean RV/LV volume (± SD) decreased (3.6 ± 0.5:1 preop vs 2.1 ± 0.8:1 postop, p < 0.001; normal subjects 1.3 ± 0.1:1), PFR increased (2.13 ± 0.57/sec vs 3. 16 1.19/sec,p < 0.01; normal subjects 2.92 ± 1.28/sec) and EF was unchanged (0.62 ± 0.12 vs 0.69 ± 0.09; NS; normal subjects 0.66 ± 0.08). In three older patients a low LV EF returned to normal postoperatively.…”