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[Follow-up of children with atrioventricular septal defect]
Anneline Paulsen1, Elisabeth Edvardsen, Leif Brunvand
1Hjertemedisinsk avdeling, Hjerte-Lungesenteret. anneline.paulsen@uus.no
Insights
Atrioventricular septal defect (AVSD) is a congenital heart condition. Annual ambulatory follow-up is recommended for operated children, with clinical exams and echocardiography being key evaluation methods.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Clinical Outcomes
Context:
- Atrioventricular septal defect (AVSD) affects 0.1-0.2% of newborns.
- This study reviewed AVSD cases within a specific geographic area and timeframe.
- Evaluation of existing follow-up protocols for pediatric AVSD patients.
Purpose:
- To provide an overview of children born with AVSD between 1983 and 1995.
- To assess the effectiveness of current follow-up routines for AVSD.
- To analyze the association between Down's syndrome and AVSD characteristics.
Summary:
- A review of 53 children with AVSD revealed 68% had Down's syndrome.
- Children with Down's syndrome exhibited lower maximal oxygen uptake and pulse rates.
- ECG, blood tests, and chest X-rays provided no additional diagnostic information.
Impact:
- Operated children with AVSD require annual or biannual ambulatory examinations.
- Clinical examination and echocardiography are the most crucial components of AVSD patient evaluation.
- Findings guide improved long-term management strategies for pediatric AVSD.
Background:
Atrioventricular septal defect (AVSD) is a complex congenital heart disease with an incidence of 0.1-0.2 per cent. We wanted to produce an overview of all children in our catchment area born with AVSD in a defined period of time and to evaluate our follow up routines in respect of AVSD.
Material And Methods:
The medical case-notes of 53 children born with AVSD between 1983 and 1995 were examined.
Results:
Eleven children had died. 42 were offered an extended examination. 36 of the 53 children (68%) had Down's syndrome; 77% (28/36) of these had complete AVSD versus 52% (9/17) of the children without Down's syndrome. The difference was not statistically significant. Children with Down's syndrome had lower maximal oxygen uptake (p = 0.01) and lower maximal pulse rate (p = 0.02). We did not find any significant association with degree of atrioventricular insufficiency, size of left atrium or pro-atrial natriuretic peptide (pro-ANP). Moreover, no association existed between the degree of atrioventricular incompetence and exercise tolerance tested on the treadmill. ECG, 24-hour ambulatory taped ECG, blood tests and chest X-ray gave no additional information.
Interpretation:
Children with AVSD who have been operated on, should be examined ambulatory every year or every second year. Clinical examination and echocardiography seem to be the most important aspect of the evaluation.