Original ArticlesIncidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery
Section snippets
Patients and methods
Between January 1988 and December 1996, 211 consecutive patients older than 18 years of age underwent surgical closure of an atrial septal defect at the Deutsches Herzzentrum, Berlin. Every consecutive adult patient with a preoperative pulmonary to systemic flow (Qp/Qs) ratio of 1.5:1 or more was included in this study on the basis that he or she had situs solitus, concordant atrioventricular and ventriculoarterial connections, and an atrial septal defect (n = 185) in the fossa ovalis
Results
There was a significant improvement (p = 0.001) in NYHA functional class after surgical closure of the atrial septal defect. There was 1% mortality with 2 deaths within 30 days of operation in patients aged 57 and 68 years. The 57-year-old patient with pulmonary hypertension (mean pulmonary artery pressure, 68 mm Hg) died of a pulmonary hypertensive crisis 8 hours after the operation. She was operated on because at the preceding cardiac catheterization she was found to respond to a combination
Comment
Our data show that the presence or absence of atrial flutter/fibrillation may be a determinant of the maintenance of sinus rhythm after operation, and that the prevalence of preoperative supraventricular tachyarrhythmias increases with age. An important result of this study is that return to sinus rhythm from preoperative atrial flutter is possible, but unlikely if fibrillation is present. Thus in the future, patients with fibrillation should be managed differently, because closure of the
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