Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy
Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients...
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2023-05-01
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| Series: | Journal of Chest Surgery |
| Subjects: |
| _version_ | 1827954189842513920 |
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| author | Byeong A Yoo Su Jin Kwon Yu-Mi Im Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Tae-Jin Yun |
| author_facet | Byeong A Yoo Su Jin Kwon Yu-Mi Im Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Tae-Jin Yun |
| author_sort | Byeong A Yoo |
| collection | DOAJ |
| description | Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated
during infancy. We evaluated the clinical characteristics and outcomes of patients who
underwent surgical ASD closure during infancy.
Methods: A single-center retrospective review was performed for 39 patients (19 males)
who underwent surgical ASD closure during infancy between 1993 and 2020. The median
body weight percentile at the time of operation was 9.3.
Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic
respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the
only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence
interval [CI], 1.75–163.04; p=0.015). The 5-year survival rate was significantly lower
in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative
ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases
in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume
(p=0.013) indices. A generalized estimated equation model showed significantly better
postoperative improvement in body weight percentiles in patients with lower weight
percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD
diameter (≥45 mm/m2, p=0.025).
Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely
small preoperatively and remain small even after surgical closure. However, postoperative
somatic growth was more prominent in smaller patients with larger defects, which may be
attributable to an increase in postoperative cardiac output due to changes in ventricular
septal configuration. The benefits of ASD closure in patients with BPD are undetermined. |
| first_indexed | 2024-04-09T14:26:16Z |
| format | Article |
| id | doaj.art-9cb4193bb79943ffbc1743f4123a221a |
| institution | Directory Open Access Journal |
| issn | 2765-1606 2765-1614 |
| language | English |
| last_indexed | 2024-04-09T14:26:16Z |
| publishDate | 2023-05-01 |
| publisher | Korean Society for Thoracic & Cardiovascular Surgery |
| record_format | Article |
| series | Journal of Chest Surgery |
| spelling | doaj.art-9cb4193bb79943ffbc1743f4123a221a2023-05-04T05:01:01ZengKorean Society for Thoracic & Cardiovascular SurgeryJournal of Chest Surgery2765-16062765-16142023-05-0156315516110.5090/jcs.22.133Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during InfancyByeong A Yoo0https://orcid.org/0000-0002-8158-3513Su Jin Kwon1https://orcid.org/0000-0003-3400-8206Yu-Mi Im2https://orcid.org/0000-0002-9695-9341Dong-Hee Kim3https://orcid.org/0000-0002-4021-8712Eun Seok Choi4https://orcid.org/0000-0002-0618-4686Bo Sang Kwon5https://orcid.org/0000-0002-0365-4339Chun Soo Park6https://orcid.org/0000-0001-8718-8904Tae-Jin Yun7https://orcid.org/0000-0002-0336-1720University of Ulsan College of MedicineUniversity of Ulsan College of MedicineDankook UniversityUniversity of Ulsan College of MedicineUniversity of Ulsan College of MedicineUniversity of Ulsan College of MedicineUniversity of Ulsan College of MedicineUniversity of Ulsan College of MedicineBackground: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75–163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m2, p=0.025). Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.congenital heart defectsatrial heart septal defectsbronchopulmonary dysplasiapediatric cardiologyinfancy |
| spellingShingle | Byeong A Yoo Su Jin Kwon Yu-Mi Im Dong-Hee Kim Eun Seok Choi Bo Sang Kwon Chun Soo Park Tae-Jin Yun Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy Journal of Chest Surgery congenital heart defects atrial heart septal defects bronchopulmonary dysplasia pediatric cardiology infancy |
| title | Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy |
| title_full | Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy |
| title_fullStr | Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy |
| title_full_unstemmed | Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy |
| title_short | Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy |
| title_sort | characteristics of patients with surgical closure of an atrial septal defect during infancy |
| topic | congenital heart defects atrial heart septal defects bronchopulmonary dysplasia pediatric cardiology infancy |
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