From the Guidelines
Ostium primum defect is classified as a moderate complexity congenital heart disease, and surgical closure is typically recommended to prevent long-term complications, as stated in the 2021 AHA/ACC guidelines comparison 1. The management of ostium primum defect depends on the size of the defect and associated symptoms.
- Small defects without symptoms may only require monitoring,
- while larger defects typically require surgical closure to prevent complications such as right heart enlargement, pulmonary hypertension, arrhythmias, and heart failure. Surgery involves patching the hole with either synthetic material or the patient's own tissue. According to the 2019 AHA/ACC guideline for the management of adults with congenital heart disease 1, ostium primum ASD is classified as a moderate complexity condition, which is consistent with the 2021 guidelines comparison 1. Patients with this condition need regular follow-up with a cardiologist, including echocardiograms to monitor heart function and structure. Endocarditis prophylaxis is recommended for six months after repair or lifelong if residual defects remain. Most patients who undergo timely repair have an excellent prognosis and can lead normal lives, though they may need lifelong cardiac follow-up. It is essential to note that the classification and management of ostium primum defect may vary depending on the specific patient's condition and associated abnormalities, and the 2021 guidelines comparison 1 provides a comprehensive overview of the current recommendations. The American College of Cardiology and American Heart Association guidelines emphasize the importance of individualized care and regular follow-up for patients with congenital heart disease, including those with ostium primum defect 1.
From the Research
Isolated Ostium Primum Defect
- The ostium primum defect is a type of atrial septal defect that occurs when there is a deficiency in the atrioventricular septation, rather than an atrial septal defect 2.
- Surgical repair of ostium primum defects in adults can result in excellent long-term outcomes, with low mortality rates and significant improvement in symptoms 3.
- A study of 33 adult patients who underwent surgical repair of ostium primum defects found that there were no operative deaths, and all surviving patients were free of exercise limitation at a mean follow-up interval of 5.3 years 3.
- Another study of 12 adult patients who underwent surgical repair of ostium primum defects found that all patients benefited symptomatically from the surgery, but all had residual cardiac murmurs, and three demonstrated residual mitral insufficiency on postoperative cardiac catheterization and left ventriculography 4.
- The morphology of the ostium primum defect has been clarified in a study that found that the key feature is a common atrioventricular junction, and that the basic deficiency is best understood as a product of defective atrioventricular septation, rather than an atrial septal defect 2.
Treatment and Prognosis
- Surgical repair of ostium primum defects is the treatment of choice, and can result in excellent long-term outcomes 3, 4.
- The use of autologous pericardium to patch the defect is a common technique, and mitral valvuloplasty or mitral valve replacement may be performed selectively 3.
- The presence of advanced age at operation, symptoms, atrial arrhythmias, mitral regurgitation, or moderately increased pulmonary vascular resistance does not predict late postoperative mortality, complications, or functional capacity 3.
- Antibiotic prophylaxis is not directly relevant to the treatment of ostium primum defects, but may be considered in certain situations, such as orthognathic surgery or orthopedic implant-related surgical site infections 5, 6.