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Enlarged right ventricular size at 11 years follow-up after closure of secundum type atrial septal defect in children


to assess ventricular dimensions, exercise capacity and rhythm-status of patients operated for secundum type atrial septal defect (ASD-II) and compare the results with those in healthy references.


Long-term prognosis of children operated for ASD-II is excellent. It remains unclear whether right ventricular (RV) dimensions completely normalize after surgery and whether this may have implications for (timing of) treatment strategies.


Seventy-eight consecutive patients underwent surgical closure for ASD-II between 1990 and 1995. Forty-two patients were included in this study and underwent a cross-sectional evaluation including echocardiography, cardiovascular magnetic resonance (CMR) imaging, exercise testing, and 24-hours Holter monitoring. For comparison of the results, ASD-II patients were matched with healthy controls for gender, body surface area (BSA) and age.


Mean age at surgery was 4.6 ± 2.8 years and mean age at follow-up 16 ± 3 years. There were no residual intracardiac lesions. Mean right ventricular end-systolic volume (RVESV) was significantly larger in patients (142 ± 26 ml) than in references (137 ± 28 ml) (p = 0.04). In 25% of the patients, RVESV was larger than the 95th percentile for healthy controls. No relevant arrhythmias were detected. Exercise testing did not reveal differences between patients and healthy controls. Maximal workload (Watt) was 169 ± 43 for patients vs. 172 ± 53 for controls (p = 0.8), maximal oxygen uptake (ml/kg/min) was 38 ± 8 for patients vs. 41 ± 13 for controls (p = 0.1).


After surgical closure of ASD-II, RVESV is increased. These findings have no impact on rhythm-status or exercise capacity at this stage of follow-up, but may have implications for the timing of surgery or the technique of closure if confirmed in longer follow-up.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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de Koning, W.B., Luijnenburg, S.E., van Osch-Gevers, L.M. et al. Enlarged right ventricular size at 11 years follow-up after closure of secundum type atrial septal defect in children. J Cardiovasc Magn Reson 11 (Suppl 1), P99 (2009).

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