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Surgical Closure of Atrial Septal Defect in Children Under Two Years of Age

Department of Cardiothoracic Surgery
¹ Department of Cardiology
² Department of Cardiac Anaesthesia, Sri Ramachandra Medical College University Hospital, Chennai, India

For reprint information contact: Usha Parvathy, MCh Tel: 91 44 2476 8403 Fax: 91 44 2476 7008 Email: cvskrb{at}giasmd01.vsnl.net.in Department of Cardiothoracic Surgery, Sri Ramachandra Medical College University Hospital, Porur, Chennai 600116, India.

Infants with atrial septal defects are seldom symptomatic and usually require elective surgery between 2 and 4 years of age. However a small minority is symptomatic and management at this age has been controversial. This study evaluated surgical closure of atrial septal defect below 2 years of age. Eighteen infants with a mean age of 13.4 ± 5.7 months were operated on for secundum atrial septal defect from 1994 to 2001. Fourteen patients were symptomatic with failure to thrive in 7 and recurrent respiratory infections in 7, one had increasing cardiomegaly, and 3 were operated on early for social reasons. The defect was isolated in 11 patients (61%) and the other 7 (39%) had minor associated lesions requiring additional procedures such as ductal ligation, direct closure of a tiny ventricular septal defect, and inspection of the mitral valve. There were no early or late deaths. The postoperative course was complicated by pulmonary problems in 4 cases. Of the 16 patients available for follow-up, 14 were asymptomatic and 2 were symptomatically improved. Most showed a dramatic improvement in growth and development. These gratifying results indicate that consideration should be given to early surgical closure of atrial septal defect in symptomatic infants.

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