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Symptomatic atrial septal defect in the neonate and infant
Insights
Congestive heart failure in infants can be caused by secundum type atrial septal defect (ASD). Early diagnosis and conservative management are often effective, allowing surgical closure to be deferred.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Secundum type atrial septal defect (ASD) is typically asymptomatic in infancy.
- Congestive heart failure is an uncommon presentation of ASD in neonates and infants.
Observation:
- Seven infants aged 2 weeks to 8 months presented with congestive heart failure.
- Cardiac catheterization revealed a left-to-right shunt in 6 patients.
- Clinical signs in infants mirrored those in older children with ASD.
Findings:
- Rapidly decreasing pulmonary vascular resistance and altered left ventricular compliance are potential causes of early heart failure.
- Six infants improved with conservative management; no spontaneous shunt closure occurred.
- One infant died, with ASD diagnosed post-mortem.
Implications:
- ASD secundum type should be considered in the differential diagnosis of infant heart failure.
- Conservative management may be sufficient, with surgery deferred to an optimal age.
- This highlights the importance of recognizing less common presentations of congenital heart defects.
Abstract:
Atrial septal defect, secundum type, is rarely diagnosed and seldom produces symptoms in infancy. 7 patients, aged between 2 weeks and 8 months, who developed congestive failure, are presented. 6 of them had an atrial LR-shunt documented at cardiac catheterization. 1 diagnosis was made at post mortem in the only infant who died. The clinical signs of an ASD do not vary from those normally found in the older child; the causes for early failure are probably rapidly decreasing pulmonary vascular reistance and disturbances of left ventricular compliance. 6 infants improved with conservative or no treatment, although spontaneous closure or significant diminution of the shunt did not occur. Surgical closure can be deferred to a later optimal age for operation. ASD secundum type should be considered as a cause of heart failure in the neonate and infant.