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Atrial septal defect with failure to thrive in infancy: hidden pulmonary vascular disease?
Rachel Andrews1, Robert Tulloh, Alan Magee
1Department of Congenital Heart Disease, Guy's and St. Thomas' Hospital, London, UK.
Insights
Surgical closure of atrial septal defects in infants is debated due to variable outcomes. In symptomatic infants, it is crucial to rule out other cardiac and non-cardiac conditions, including pulmonary vascular disease.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Atrial septal defects (ASDs) are typically asymptomatic in children and managed in preschool years.
- Symptomatic presentation in infancy is rare, with debated management strategies.
- Surgical closure is a common intervention for ASDs.
Observation:
- This study reports on six infants undergoing surgical closure for symptomatic atrial septal defects.
- Five of the six infants presented with significant extracardiac pathology.
- Outcomes following surgical intervention were variable across the cohort.
Findings:
- Symptomatic infants with atrial septal defects often have complex medical histories.
- The presence of extracardiac pathology may influence surgical outcomes.
- The benefit of surgical closure in this specific population requires careful consideration.
Implications:
- Further investigation is needed to identify underlying causes of symptoms in infants with ASDs.
- Differentiating ASDs from other cardiac and non-cardiac conditions is critical for appropriate management.
- The role of primary pulmonary vascular disease in symptomatic infants with ASDs warrants further evaluation.
Abstract:
Atrial septal defects are usually asymptomatic, and are closed surgically or by a catheter implanted device in preschool age children. Rarely, they may cause symptoms in infancy, and management at this age is debated. We report our experience of six infants who underwent surgical closure, with variable outcomes. Five of these had significant extracardiac pathology. Our data suggest the need to exclude other causes of symptoms, both cardiac and non-cardiac. The question should be asked as to whether surgery is of benefit in these children, and particularly whether they may have underlying primary pulmonary vascular disease.