PM1032: Utility of Follow-up Echocardiograms in Uncomplicated Surgical Secundum Atrial Septal Defect Closures

Background: Though less common in the current era, surgical closure of secundum atrial septal defects (ASD2) are still performed in certain clinical situations. Guidelines recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who had a surgical ASD2 closure. Goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated ASD2 closure.

Methods: Chart review was performed on patients who had a surgical ASD2 closure between 1/1/1996 – 6/1/2020. Patients were excluded if they had other congenital heart disease, did not have a follow-up TTE > 1 year after procedure, or had the diagnosis of a residual ASD2, atrial/ventricular arrhythmias, pulmonary hypertension, or heart failure one year post repair. Most recent TTE’s and clinic notes were evaluated.

Results: Total of 30 patients met criteria. Median age at ASD2 surgery was 4.0 years (0.9 – 20.3 years). ASD2 was closed via patch repair in 16 patients and primarily closed in 14 patients. Most recent TTE was performed a median of 10.4 years (1.1 – 19.2 years) after ASD2 closure. Two patients had mild right atrial and ventricular dilation, one patient had mild right atrial dilation, and one patient had mild right ventricular dilation. All other patients had qualitatively normal right sided chamber sizes. All patients had normal biventricular function (left ventricular fractional shortening, 38.0 + 7.7%), no evidence of residual atrial shunts, and no evidence of pulmonary hypertension. No patient was on any cardiac medications at last clinic visit. Four patients were discharged from cardiology clinic and 10 patients were lost to follow-up. There were no deaths noted. Twenty-four patients had 46 repeat echocardiograms > 1 year after ASD2 with no change in clinical management.

Conclusion: In patients who underwent an uncomplicated ASD2 closure during infancy, there were no significant abnormalities noted on follow up TTE’s. The need for repeat lifetime TTE’s in this uncomplicated population should be reassessed if larger studies with longer follow-up confirm these initial findings.