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Atrial septal defect in Malta
1Paediatric Department, St. Luke's Hospital, Guardamangia, Malta. vgrech@mail.link.net.mt
Insights
This study on atrial septal defect (ASD) found diagnosis and surgical trends improved significantly. Early, noninvasive diagnosis and reduced mortality highlight ASD
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrial septal defect (ASD) is a common congenital heart malformation.
- Understanding diagnostic and surgical trends is crucial for patient management.
- Population-based data provides insights into disease prevalence and natural history.
Purpose of the Study:
- To analyze diagnostic and surgical trends for atrial septal defect (ASD).
- To estimate the birth prevalence of ASD.
- To determine spontaneous closure rates of ASD.
Main Methods:
- Population-based cohort study in Malta (1990-1994).
- Identification of all diagnosed ASD cases born within the study period.
- Echocardiographic follow-up for non-intervention cases.
Main Results:
- 190 ASD cases identified; significant decrease in age at diagnosis and surgery.
- Shift towards entirely noninvasive diagnostic methods.
- Dramatic reduction in perioperative mortality over time.
- Birth incidence: 2.0/1000 live births (non-intervention) and 0.4/1000 (intervention).
- 92% of non-intervention ASDs closed spontaneously; others decreased in size.
Conclusions:
- Atrial septal defect (ASD) is generally a benign condition.
- Early and noninvasive diagnosis is achievable.
- Interventional mortality for ASD is extremely low.
Objective:
To study diagnostic and surgical trends in atrial septal defect (ASD) in a population-based study, and estimate birth prevalence and spontaneous closure rates.
Methodology:
All patients in Malta diagnosed as having ASD and born between 1990 and 1994 were identified from various sources. This took place in the setting of a regional hospital supplying diagnostic services for the entire population. Echocardiographic follow-up was also undertaken for lesions not requiring intervention.
Results:
A total of 190 patients born in this period were diagnosed as having ASD. Age at diagnosis and age at surgery have decreased significantly over the period under study (P < 0.0001). The mode of diagnosis has become entirely noninvasive, and the perioperative mortality decreased dramatically over time. For the period 1990-94, the incidence at birth for defects not requiring intervention was 2.0/1000 live births, defects requiring intervention 0.4/1000 live births. A total of 92% of 50 defects not requiring intervention closed spontaneously, and the remainder had spontaneously decreased in size on follow-up.
Conclusions:
ASD is a relatively benign malformation in which early and noninvasive diagnosis can be achieved, with an extremely low interventional mortality.