SURGICAL CLOSURE OF ATRIAL SEPTAL DEFECT (ASD) IN CHILDHOOD IN THE CURRENT ERA. Holley DG*, Sholler GF, Chard RB, Andrews DR, Nunn GR. Adolph Basser Cardiac Institute, Royal Alexandra Hospital Children (New Children's Hospital), Westmead, Sydney. Surgical closure of ostium secundum ASK is associated with low mortality (<1%). Morbidity can be associated with hospitalisation, general anaesthesia, sternotomy, cardiopulmonary bypass and intensive care stay. This is of increased interest as comparative data, with wider use of catheter closure. Objective: Determine perioperative morbidity of surgical closure of ASD. Methods: Retrospective review of the last 100 consecutive cases from July 1996 -Oct 1999 was performed using medical records and database review. Results: Age range 10 months to 16 years, with 45 children aged 1-3 years, (M;36, F:64). Total days of hospitalisation: 683 (range 5-44 days; median 6 days). Total intensive care days: 127.4 (range 0.8-21.8 days; median 1 day). Ninety-nine patients were ventilated for < 24 hours. There were no deaths. 86% of patients had an uncomplicated course, with hospital days 549 (range 5-10 days, median 6 days). 14% had complications: 1 patient required prolonged ventilation for pulmonary hypertension/presumed viral respiratory tract infection. Re-operation was required at 7 months post-operatively for 1 patient for painful sternal wires. Pericardial effusion developed in 4 patients, 2 cases requiring readmission, one drainage. One patient was readmitted for 2 days of IV antibiotics for pneumonia. Two patients had right Horner's syndrome presumed secondary to insertion of internal jugular lines. Minor complications included left lower lobe atelectasis (3), post-operative ileus (1), intravenous line site infection (1) and left pleural effusion (1), no drainage required. Ninety-four patients were seen at follow-up. On echocardiogram 88/89 patients had no residual defect. One patient had a small residual defect at 1 month post-operation. Conclusion: Surgical secundum ASD repair is associated with short hospital stay and a low rate of significant complication with 99% complete closure. |
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