Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy

  • Byeong A Yoo (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Su Jin Kwon (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu-Mi Im (Department of Nursing, Dankook University) ;
  • Dong-Hee Kim (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eun Seok Choi (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Bo Sang Kwon (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chun Soo Park (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae-Jin Yun (Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.11.03
  • Accepted : 2023.01.12
  • Published : 2023.05.05
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Abstract

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.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

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