Twenty-two Years of Repair of Atrial Septal Defects in Ghana

Abstract

Introduction: Atrial septal defects (ASDs) are one of the most common types of congenital heart disease. Repair is often necessary to forestall the various complications associated with the natural history. Surgical repair under cardiopulmonary bypass has been
one of the standard modes of treatment. Much of the data available is from the rest of the world. There is not much data from the West African sub region. The purpose of this study is therefore to provide data from this sub region, guide both referring and operating clinicians in their decisions, and also to serve as comparative data for future studies. We analysed our institutional data to determine the age and sex distribution, the types of ASD and the outcome of surgical repair.
Subjects and Methods: A retrospective study was done for all patients who had surgical repair of ASD from January 1992 to December 2013 in the National Cardiothoracic Centre. The data was analysed using Microsoft excel 2010 software.
Results: There were 129 patients, 2 in the first year and 9 in the last year of the study. There were 53 (41.0%) males and 76 (59.0%) females. The mean age was 17.6 ± 14.9 years (1 – 70), The commonest age group was 1 – 10 years; 53 (41.0%), followed by 11 – 20
years; 36 (27.9%). Secundum ASDs were the commonest, 104 (80.6%), followed by primum ASDs 14 (10.9%), and sinus venosus ASDs 6 (4.7%). Large defects described as common atrium were 5 (3.9%). Autologous pericardium was used in repairing 125 (96.9%) and GORETEX® patch was used in the remaining 4 (3.1%). Thirty-three (25.7%) cases had associated cardiac anomalies that needed concomitant surgical intervention. The commonest was cleft in the anterior mitral leaflet causing severe mitral regurgitation 12 (9.3%), followed by pulmonary stenosis (PS) 11 (8.5%). There was an early mortality of 2 (1.6%). No other significant complication was
encountered.
Conclusion: Surgical repair of ASDs in this sub region has been going on for over two decades now, with excellent outcomes. Patients with ASDs must be offered repair as soon as possible to forestall the serious complications that may follow unrepaired ASDs