Structural Basis for Mitral Valve Dysfunction Associated with Ostium Secundum Atrial Septal Defects

Abstract

Mitral valve (MV) specimens obtained at operation from 50 patients with ostium secundum atrial septal defect and associated MV dysfunction were studied macro- and microscopically to evaluate the structural lesions. The functional abnormalities in these patients were isolated mitral stenosis, isolated mitral regurgitation, mitral valve prolapse or mitral stenosis with regurgitation. Post-inflammatory lesions were commonly found in those with mitral stenosis who had a past history of rheumatic fever. Patients with mitral valve prolapse had either post-inflammatory lesions or lesions attributable to hae-modynamic stress but different from the extensive lesions seen in floppy MV syndrome.

Preoperative and Postoperative Mitral Valve Prolapse and Regurgitation in Adult Patients with Secundum Atrial Septal Defects

“…Prior investigators showed that involvement of anterior leaflet was found in more than half of ASD patients with MV prolapse 2–4 . This study also showed that 72% of ASD patients had anterior leaflet prolapse.…”

“…Prior investigators showed that involvement of anterior leaflet was found in more than half of ASD patients with MV prolapse. [2][3][4] This study also showed that 72% of ASD patients had anterior leaflet prolapse. Other study has shown that posterior leaflet prolapse and bileaflet prolapse are likely to remain unchanged even after ASD closure.…”

“…Substantial MR was shown to be present in less than 10% of adult patients with ASD 18 . Other investigators showed that only 2% of ASD patients except rheumatic heart disease had significant MR enough to require simultaneous MV surgery at the time of ASD closure 2 . According to their study, the prevalence of MV surgery for ASD patients was equal to 5% of the procedures for isolated MV disease.…”

“…Atrial septal defect (ASD) is a congenital cardiac abnormality often encountered in adults, as many patients are free from overt symptoms for the first few decades and may show few signs of ASD on physical examination 1 . Substantial mitral regurgitation (MR) has been shown to be present in less than 10% of adults with large ASD mainly caused by mitral valve (MV) prolapse in relation to abnormal geometry of the left ventricle (LV) and MV apparatus secondary to right ventricular (RV) volume overload 2,3 . Isolated ASD closure has been known to affect LV geometry and to correct MV prolapse in adolescents and young adults.…”

“…1 Substantial mitral regurgitation (MR) has been shown to be present in less than 10% of adults with large ASD mainly caused by mitral valve (MV) prolapse in relation to abnormal geometry of the left ventricle (LV) and MV apparatus secondary to right ventricular (RV) volume overload. 2,3 Isolated ASD closure has been known to affect LV geometry and to correct MV prolapse in adolescents and young adults. However, data on older ASD patients were limited.…”