A Reappraisal of Life Expectancy with Atrial Shunts of the Secundum Type

¹ Department of Medicine, Vanderbilt University School of Medicine

The life history of 74 patients who died between the ages of one day and 82 years with isolated secundum-type atrial septal defects is reported. In addition, 2455 previously reported cases with this defect are reviewed.

Secundum-type atrial defects were divided into four clinical syndromes: first, patients who died during infancy; second, patients who developed a bidirectional or reversal of the shunt in middle age; third, patients who led an active life for 50 to 82 years without surgery; fourth, patients who underwent surgery for repair of the atrial defect.

Events such as congenital pulmonary vascular abnormalities, recurrent pulmonary infarction, pulmonary hypertension, atrial fibrillation, and/or degenerative heart disease alter the clinical course and decrease the life expectancy of atrial septal defects.

No direct correlation was found between the size of the defect and the duration of life. As a matter of fact, the majority of individuals that lived for 50 to 82 years had large defects, yet others with small defects of the atrial septum developed lethal complications at an early age.

With improved medical management of pulmonary infection by antibiotic therapy, of pulmonary infarction by anticoagulation, of cardiac arrhythmias and failure by replacement of electrolytes and the administration of more effective diuretics, the life expectancy with atrial defects should increase.

With improved surgical techniques and experience, the overall surgical mortality has dropped from 4 per cent to near 1 per cent. A careful individual case selection, however, should be undertaken before surgical repair is recommended. One of the most pressing indications for surgical repair of an atrial septal defect is the development of pulmonary hypertension provided there is not high pulmonary vascular resistance and a reversal of the shunt.