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Analyse der chirurgischen Therapie des Vorhofscheidewanddefektes (ASD) bei Adoleszenten und Erwachsenen

Long term follow-up after surgical closure of atrial septal defect (ASD) in adults

  • ORIGINALARBEIT
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Fragestellung

Ziel unserer Studie war die Erfassung und Analyse der Langzeitergebnisse bei adoleszenten und adulten Patienten nach operativer Therapie des Atriumseptumdefektes (ASD).

Methodik

Wir analysierten 106 konsekutive Patienten, die wegen eines Atriumseptumdefektes (ASD) im Alter von 16 bis 74 Jahren (Alter: 39,2±16,3 J; w:m/69: 37) in einem Zeitraum von 15 Jahren operiert wurden.

Ergebnisse

16% der Patienten boten präoperativ Herzrhythmusstörungen. Diese waren bei einem Alter von über 50 Jahren signifikant häufiger (p=0,001). 78 Patienten (74%) zeigten eine Rechtsherzbelastung im EKG oder im TTE/TEE. 36% davon wiesen eine pulmonale Hypertonie auf. Sowohl der systolische als auch der mittlere Pulmonalarteriendruck korrelierten positiv mit dem Alter des Patienten (r=0,3; p=0,007 bzw. r=0,22; p=0,046). 12 Patienten (11,3%) hatten präoperativ embolische Ereignisse: 5 Apoplex, 5 rezidivierende TIA- und 2 periphere Emboliefälle. Die perioperative Mortalität betrug 0%. Ein Follow-up war bei 73 Patienten (69%) nach 5,4 Jahren möglich (Min.: 0,84, Max. 14,1 Jahre). 53% der Patienten mit präoperativen Herzrhythmusstörungen wiesen zum Zeitpunkt des Follow-up einen Sinusrhythmus auf. Im Schnitt hatte sich das Patientenkollektiv um 1,3 NYHA-Klassen verbessert. Die Verbesserung in der NYHA-Klassifikation war unabhängig vom Alter zum Zeitpunkt der Operation (p>0,05). Die 5- bzw. 10-Jahres-Überlebensrate betrug unabhängig vom präoperativen Pulmonalarteriendruck nach Kaplan-Meier 97 bzw. 93%.

Schlussfolgerung

Die Langzeitergebnisse der chirurgischen Behandlung adoleszenter und adulter Patienten mit ASD zeigen eine deutliche Verbesserung der Rhythmusstörungen sowie des NYHA-Stadiums und damit der Lebensqualität.

Summary

Background

The aim of this study was the analysis of the long-term follow-up of young and adult patients with atrial septal defect after surgical therapy.

Methods

We analyzed 106 patients with atrial septal defect (ASD) between 16 and 74 years (mean 39.2±16.3 y; w:m/69 : 37) who underwent a surgical defect closure over a 15 year period.

Results

In 16% of the patients cardiac arrhythmias were observed in the preoperative period. The incidence of arrhythmias was significant higher in the patient group over 50 years (p=0.001). 78 patients (74%) showed a right heart volume overload in the ECG and echocardiography, while 36% had a pulmonary hypertension. Twelve patients (11.3%) had emobolic events: 5 patients with apoplexy, 5 with transitory ischemic attack and 2 patients with peripheral embolism. The perioperative mortality was 0%. A follow-up was performed with 73 patients (69%) within 5.4 years after operation (min: 0.84, max: 14.1 years). 53% of patients with preoperative arrhythmia showed regular sinus rhythm. The NYHA stadium of the study group was 1.3 NYHA class lower than preoperative irrespective of age and year of operation (p>0.005). The 5 and 10 year survival rate was 97 and 93%, respectively, independent of pulmonary arterial pressure.

Conclusions

Adolescent and adult patients with ASD have a benefit of surgical therapy in reduced arrhythmia rate and improvement in their NYHA class and thus in their quality of life.

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Authors and Affiliations

  1. Klinik für Herz-, Thorax- und Gefäßchirurgie, Klinikum der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55101, Mainz

    W. Kuroczynski, A. Paivandi, D. Wagner, B. Cronen, M. Heinemann, D. Pruefer & Ch.-F. Vahl

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  1. W. Kuroczynski
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  2. A. Paivandi
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  3. D. Wagner
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  4. B. Cronen
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  5. M. Heinemann
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  6. D. Pruefer
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  7. Ch.-F. Vahl
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Correspondence to W. Kuroczynski.

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Kuroczynski, W., Paivandi, A., Wagner, D. et al. Analyse der chirurgischen Therapie des Vorhofscheidewanddefektes (ASD) bei Adoleszenten und Erwachsenen. Z Herz- Thorax- Gefäßchir 20, 96–101 (2006). https://doi.org/10.1007/s00398-006-0535-3

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  • DOI: https://doi.org/10.1007/s00398-006-0535-3

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