Chest
Volume 94, Issue 2, August 1988, Pages 321-324
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Long-term Follow-up of Partial Atrioventricular Septal Defect Repair in Adults

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Patients presenting with partial atrioventricular septal (PAVC) defects in adulthood are rare. Eight adult patients with this congenital heart defect who had surgical repair are described, along with their long-term postoperative follow-up data. Average age at operation was 48 years, and average follow-up was 13.4 years. There was no operative mortality. All but one patient were in NYHA functional class 1 or 2 postoperatively. Three patients had suffered late onset of progressive mitral regurgitation leading to severe congestive heart failure 15 to 25 years postoperatively. The number of adult patients with repaired PAVC defects who have eventual mitral valve deterioriation may be higher than estimated in the current literature. Because of the unpredictability of mitral valve function, lifelong follow-up should be stressed in these patients.

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MATERIAL AND METHODS

Between February 1959 and 1984, eight adult patients with PAVS defects underwent operative repair. Their ages ranged from 31 to 65 years, with a mean of 48 years. The diagnosis was made using physical examination, electrocardiography, chest x-ray film, and cardiac catheterization in all cases. The average follow-up period was 13.4 years. Clinical data, cardiac catheterization results, operative findings, methods of repair, and postoperative information are summarized in Table 1.

All but one

RESULTS

Overall the patients improved symptomatically following operative repair an average of 1.5 NYHA functional classes. All but one patient improved postoperatively to NYHA functional class 1 or 2, including five of six patients who presented as NYHA functional class 3 or 4 (Fig 1).1

There was no hospital mortality among these eight patients. Postoperative complications were encountered in four patients. One patient went into complete heart block during the operative repair in 1959. His heart rate

DISCUSSION

Few cases of PAVS defects reach adulthood without diagnosis and surgical correction.2 Most larger series of patients with PAVS defects contain a few adult patients aged 30 years or older, but there is relatively little information regarding their long-term results.3, 4, 5, 6, 7, 8

In general, the prognosis of adult patients with surgically repaired PAVS defects has been extrapolated from children with repaired PAVS defects or from adults with other repaired ASDs.9, 10 Somerville11 reviewed the

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Manuscript received October 12; revision accepted February 9.

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