Pronostic De La Chirurgie Des Communications Interauriculaires En Htap Sévère

Résumé: Objective Inter atrial septal defect (ASD) are common and account for 10% of heart disease diagnosed at birth and 30 to 40% in adulthood with an estimated prevalence of 14to 24/10000. Not operated; they expose to rhythm disorders, right ventricular failure and pulmonary vascular disease (Eisenmenger risk of less than 10%).Their diagnosis is increasing early to the generalization of the Doppler echo in our country; their surgical treatment is unquestionable in children but is a difficult one for adults. The purpose of this study is to report the experience of our center in the surgical management of the (ASD) discovered in adulthood. Methods Between 2000 and 2018, 632 patients were operated for ASD; among them, 75patients had an pulmonary systolic arterial pressure upper to 60 mm Hg. This is47women and 28men (sex ratio: 0.56); 13 to61 years of age (mean age 29.9 years).The evolution of the symptoms vary from one month to 29 years; NYHA I to IV; ICT0.44 to 0.72; 66 patients were sinusal rhythm and 8 arrhythmia; ASD/ OS in70 patients and sinus venosus ASD in 4 patients and 1 patch recanalization. Ejection fraction varies from 30 to 80%; right ventricle size varies from 24 to 56mm; pulmonary artery pressure ranges from 60 to106 mmHg (mean: 69.9). Results It is an elective surgery in all patients except one patient; 1 patient underwent synthetic patch closure,74 autologous pericardial patch, mitral valve replacement in 3 patients, mitral plasty: 3; tricuspid plasty: 37aortic clamping of 37.6 min (11-100) ; Inotropic +: 12/75 Patients (16 %) , average ventilation 2 h at186 days, ICU stay of 0-18 days average, length of hospitalization of 0-77days, ICU complications 7/75 (9,33 %), hospital complications 6/75 (8 %) ; 3deaths of various causes. Pulmonary arterial systolic pressures vary from 20 to 80 mm Hg. Conclusion ASD surgery in adulthood has special characteristics that differentiate congenital cardiac surgery in children. Short and medium-term results are excellent. The long-term results require follow-up and are being evaluated.

Publié dans la revue: The Algerian Cardiac Surgeon