Pediheart: Pediatric Cardiology Today
Oct 23, 2026 · 32 min · 13 segments
In this week's episode from 3 years ago we review a Dutch study on 50 year follow-up of patients who had ASD repaired at an average age of 7.5 years. How do these patients compare to their middle aged…
Robert PassHostRobert Martijn KaulingGuest
The work begins with some general comments about atrial septal defects, reminding us that the birth prevalence is 1.6 per 1,000 and how they comprise 5 to 10% of all congenital heart disease.
They review that ASDs can result in right ventricular volume overload and even pulmonary hypertension, as well as atrial arrhythmias and paradoxical emboli, and how the first surgical closure of an ASD was performed in 1952.
And the authors explained that they had been reporting on a series of patients who were repaired in the Netherlands between 1968 and 1980 at an age less than 15 years.
and they explain that they have previously reported on this cohort in 1990, 2001, and 2011.
In many ways, as I read this, it reminded me of the wonderful British series entitled Up, which was spearheaded by the documentary director Michael Apted, that's followed 14 children in their lives in England since 1964, checking in with them roughly every 10 years.
The authors explained that alive patients who were in the original cohort at this hospital and who agreed to participate had a full medical history, 12-lead electrocardiogram, CPET, 24-hour Holter, transthoracic echo, cardiac MRI, lab measurements, and a 36-item short-form health survey.
The authors matched the survival data to those who were 7.5 years of age at the time of inclusion period and who did not have congenital heart disease.
And they explained what they consider to be major cardiac events in this study, as well as heart failure.
Ninety-three patients were approached to be in this latest iteration of this study, and of these, 86% or 80 patients agreed to participate.
The current mean age was 52 years, with a range of 41 to 63, and a median follow-up was 45 years from surgery, with a range of 40 to 51 years, and the authors explained that there were no significant differences in the baseline characteristics of those who participated in this study and those who did not.
In general, it's excellent, with cumulative survival after ASD surgery being 100%, 98%, 94%, and 86% 10, 20, 30, 40, and 50 years following atrial septal defect surgery, respectively.
Importantly, survival at 50 years was not statistically different compared to the general Dutch population, and there's a nice curve demonstrating that in figure 1 for those of you who are reading this work.
Cumulative event-free survival after 45 and 50 years was 59% and 46%, respectively, with re-intervention seen in 6 patients, with 3 of these being intervention to re-close in ASD that had been surgically closed before.
Importantly, the most common problem in these patients was perhaps not surprisingly arrhythmia, which was present in 25 patients with atrial flutter being the most common, though AFib was seen in some, and 10 patients had a catheter ablation.
The cumulative burden of symptomatic arrhythmia at 45 and 50 years post-op was 25% at 45 years and 35% at 50 years.
Thus, as a rule of thumb, we can, based on this paper, state that in the 50 years following ASD repair that is uncomplicated, the overall risk of an arrhythmia, which is usually an atrial arrhythmia, is about 1 in 3.
Two patients developed endocarditis, but both had pacemakers, and three patients had symptomatic heart failure.
Finally, eight patients had an ischemic stroke, but in one there was a residual ASD.
Importantly, there were no factors that were associated with any of these adverse events.
The work begins with some general comments about atrial septal defects, reminding us that the birth prevalence is 1.6 per 1,000 and how they comprise 5 to 10% of all congenital heart disease.
They review that ASDs can result in right ventricular volume overload and even pulmonary hypertension, as well as atrial arrhythmias and paradoxical emboli, and how the first surgical closure of an ASD was performed in 1952.
And the authors explained that they had been reporting on a series of patients who were repaired in the Netherlands between 1968 and 1980 at an age less than 15 years.
and they explain that they have previously reported on this cohort in 1990, 2001, and 2011.
In many ways, as I read this, it reminded me of the wonderful British series entitled Up, which was spearheaded by the documentary director Michael Apted, that's followed 14 children in their lives in England since 1964, checking in with them roughly every 10 years.
The authors explained that alive patients who were in the original cohort at this hospital and who agreed to participate had a full medical history, 12-lead electrocardiogram, CPET, 24-hour Holter, transthoracic echo, cardiac MRI, lab measurements, and a 36-item short-form health survey.
The authors matched the survival data to those who were 7.5 years of age at the time of inclusion period and who did not have congenital heart disease.
And they explained what they consider to be major cardiac events in this study, as well as heart failure.
Ninety-three patients were approached to be in this latest iteration of this study, and of these, 86% or 80 patients agreed to participate.
The current mean age was 52 years, with a range of 41 to 63, and a median follow-up was 45 years from surgery, with a range of 40 to 51 years, and the authors explained that there were no significant differences in the baseline characteristics of those who participated in this study and those who did not.
In general, it's excellent, with cumulative survival after ASD surgery being 100%, 98%, 94%, and 86% 10, 20, 30, 40, and 50 years following atrial septal defect surgery, respectively.
Importantly, survival at 50 years was not statistically different compared to the general Dutch population, and there's a nice curve demonstrating that in figure 1 for those of you who are reading this work.
Cumulative event-free survival after 45 and 50 years was 59% and 46%, respectively, with re-intervention seen in 6 patients, with 3 of these being intervention to re-close in ASD that had been surgically closed before.
Importantly, the most common problem in these patients was perhaps not surprisingly arrhythmia, which was present in 25 patients with atrial flutter being the most common, though AFib was seen in some, and 10 patients had a catheter ablation.
The cumulative burden of symptomatic arrhythmia at 45 and 50 years post-op was 25% at 45 years and 35% at 50 years.
Thus, as a rule of thumb, we can, based on this paper, state that in the 50 years following ASD repair that is uncomplicated, the overall risk of an arrhythmia, which is usually an atrial arrhythmia, is about 1 in 3.
Two patients developed endocarditis, but both had pacemakers, and three patients had symptomatic heart failure.
Finally, eight patients had an ischemic stroke, but in one there was a residual ASD.
Importantly, there were no factors that were associated with any of these adverse events.
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