Abstract
Surgical treatment of 14 adult patients with endocardial cushion defect (ECD) between July 1975 and June 1987 was reviewed. The ages ranged from 28 years to 57 years (mean 40). There were 11 females and 3 males.
Pulmonary-sytemic flow ratios ranged from 1.90 to 4.16 (mean 2.92). Atrial septal defects were closed with patches in all cases. Mitral clefts were not touched in 2 cases, repaired at cleft base in 7 cases, repaired at cleft base plus given annuloplasty by Kay's method in 2 cases, and replaced with prosthetic valves in 3 cases. Tricuspid valve replacement was performed in 4 out of 14 (29%) cases. There was one early death due to low cardiac output and one late death due to multiple organ failure. Postmortem histological examination revealed vacuolous degeneration of myocardial cells and thickened intima of pulmonary arteriolae in the former case. Both patients were more than 50 years old and had histories of congestive heart failure. Postoperative improvements in NYHA functional classification and cardiomegaly on chest X-ray were significant in all surviors, and there were no differences between patients with and without heart murmur. Five of 12 survivors were noted to have heart murmur, however pulmonary artery pressure improved and only trace mitral regurgitation remained, as demonstrated by postoperative examination. In conclusion, surgical treatment may be performed for even adult patients with ECD, but it is advisable before cariac function decreases to decompensation and in those whose age exceeds the natural history, that is in the forties or fifties.
