How is atrial septal defect treated in the elderly?

Whether an atrial septal defect in the elderly requires surgery** depends on the severity of the atrial septal defect.

First, the atrial septal defect is not serious, such as a small atrial septal defect, because the defect is less than five millimeters, it often does not affect the hemodynamic changes of the heart, nor does it cause the structure of the heart to enlarge, and this situation does not require surgery**. However, this defect may increase atrial thrombosis, and medications such as aspirin** need to be taken under the guidance of a doctor to prevent blood clots.

Second, severe defects, such as medium-sized atrial septal defects, especially large atrial septal defects, can cause heart failure and heart enlargement. If there are symptoms of heart failure and there is no concomitant severe pulmonary hypertension, prompt surgery can be performed**.

The methods of atrial septal defect generally include the methods of interventional surgery and the methods of surgery. In addition, some children with atrial septal defect, because the child is relatively young, or the degree of atrial septal defect is relatively mild, we can first conduct close observation and then follow-up.

Some children may recover on their own as they grow and develop. Children who cannot recover, or children with large atrial septal defects and obvious symptoms, need surgery. Interventional surgery, through the vascular implantation of the lower limbs, the umbrella passage is blocked.

Blocking the location of the umbrella passage to the housing area can block the defect and achieve the purpose. Surgery, suitable for those who are not suitable for interventional surgery. The surgical method is thoracotomy, cardiopulmonary bypass is established, and the defect is closed with mesh or pericardial repair.

For patients over 1 year old with secondary foruntum atrial septal defect rarely closed spontaneously, for asymptomatic children, if the defect is less than 5 mm, it can be observed, and if there is enlargement of the right atrium and right ventricle, surgical repair is generally recommended before school age. Congestive heart failure occurs in about 5% of infants within the first year of life. Surgery can also be performed if the results of internal medicine are not good.

Adults with defects less than 5 mm and no right atrial ventricular enlargement can be observed clinically without surgery. Adult disease such as the presence of right atrioventricular enlargement can be operable**, and concomitant surgery can be performed in patients with atrial fibrillation, but surgery is contraindicated in patients with pulmonary vascular resistance greater than 12 units, right-to-left shunts, and cyanosis.

Minimally invasive transcardiac catheterization may be indicated for some secondary foramen atrial septal defects if appropriately placed**. Through the femoral vein cannula, the nitinol occluder is clamped at the atrial septal defect to close the atrial septal defect to achieve the best purpose. No thoracotomy is required.

The secondary foratic atrial septal defect is often repaired directly under cardiopulmonary bypass via the median sternal approach, and the right anterolateral incision can also provide good surgical exposure, but other types of cardiac malformations need to be excluded. Small secondary foramen atrial septal defects can be sutured directly, if the defect is large, it needs to be repaired with a heart wrap or polyester patch, and it is important to inject water into the left atrium before repair to prevent air embolism after rebeat.

The repair of venous sinus atrial septal defect is more complicated, generally through the superior vena cava directly inserted into the drainage tube to increase the defect exposure, the repair must identify the right upper pulmonary vein opening and avoid the sinus node, the mesh must be sewn to the right atrial wall at the front of the right pulmonary vein inlet to ensure pulmonary vein drainage into the left atrium, if necessary, the mesh needs to widen the upper vena cava inlet to prevent venous return obstruction.

Older patients with atrial septal defect have a higher incidence of postoperative sinus bradycardia, and isoproterenol or atropine can be used to increase the heart rate, and intraoperative placement of temporary pacing electrodes is an effective measure.

It should be an adult, it seems from the report that it is only an atrial septal defect, if it is ** type, it does not cause pulmonary hypertension, and it is more than 3mm away from the mitral valve and tricuspid valve, it is recommended to have interventional surgery, no surgery, the effect is very good, only an umbrella is needed to close the defect mouth.

It is highly recommended to go to a regular hospital with a strong cardiovascular system.

Small atrial septal defects have the possibility of self-healing and self-healing, at present, your child is only more than 50 days old, the possibility of self-healing closure is high, and the follow-up of 2 to 3 years old, even if it is not closed, if the ultrasound defect is not large (less than 5mm), surgery is not required**.

Zhao Yonghong, Shanghai Sixth People's Hospital.