Impact of anatomic closure on somatic growth among small, asymptomatic children with secundum atrial septal defect

Area of Science:

• Pediatric Cardiology
• Growth and Development
• Congenital Heart Disease

Background:

• Children with isolated secundum atrial septal defect (ASD) often present with growth deficits.
• Preoperative growth parameters are crucial for assessing the impact of ASD on a child's development.

Purpose of the Study:

• To evaluate the effect of surgical repair of ASD on the growth of undersized children.
• To determine if early surgical intervention improves height and weight z scores in pediatric patients with ASD.

Main Methods:

• Retrospective analysis of 92 children aged ≤9 years with isolated ASD and preoperative low height or weight (z score ≤1.0).
• Comparison of growth improvement between low-weight/low-height groups and age-, gender-, and size-matched controls post-ASD repair.
• Univariate and multivariate analyses to assess factors influencing growth improvement.

Main Results:

• 50% of low-weight patients achieved a +0.5 SD weight improvement in 2.6 years vs. 5.6 years for controls (p=0.02).
• 50% of low-height patients achieved a +0.5 SD height improvement in 1.7 years vs. 11.6 years for controls (p<0.001).
• Repair offered significant benefits for height (RR 5.11) and weight (RR 2.35) improvement; older age and higher weight at repair were associated with less growth improvement.

Conclusions:

• Surgical repair of ASD significantly enhances growth in undersized children.
• Poor growth in children with ASD should be considered a relative indication for early surgical intervention.