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Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study
Andreas Hanslik1, Ulrich Pospisil, Ulrike Salzer-Muhar
1Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Insights
Most isolated atrial septal defects (ASDs) in children close spontaneously or significantly reduce in size. Initial ASD diameter is the key predictor for spontaneous closure in pediatric cardiology patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Atrial septal defects (ASDs) are common congenital heart anomalies.
- Isolated secundum ASDs require monitoring for spontaneous closure or need for intervention.
Purpose of the Study:
- To determine the rate of spontaneous closure of isolated secundum ASDs in children.
- To identify predictors for spontaneous closure or significant regression of ASDs.
Main Methods:
- Retrospective cohort study of 200 pediatric patients with isolated ASDs.
- Serial 2-dimensional echocardiography monitoring for over 6 months.
- Logistic regression analysis to identify predictors of closure/regression.
Main Results:
- 62% of ASDs showed spontaneous closure (34%) or regression to ≤3 mm (28%).
- Smaller initial ASD diameter (4-5 mm) predicted spontaneous closure (56%) or regression (30%).
- Larger ASDs (>10 mm) rarely closed spontaneously and often required intervention (77%).
Conclusions:
- Spontaneous closure or significant regression of isolated secundum ASDs is common in children.
- Initial ASD diameter is the primary predictor for spontaneous closure and regression.
Objectives:
The goals were to assess the frequency of spontaneous closure of isolated secundum atrial septal defect in children and to identify predictors of spontaneous atrial septal defect closure.
Methods:
A retrospective cohort study was performed in a tertiary care pediatric cardiology center. Consecutive patients (n = 200) diagnosed as having isolated atrial septal defects (no multiple or fenestrated atrial septal defects, no additional congenital heart disease, and no syndromes) were monitored for > 6 months with serial 2-dimensional echocardiography, according to a standardized protocol.
Results:
The median age at diagnosis was 5 months (minimum: 0 months; maximum: 13.9 years). The atrial septal defect diameter at diagnosis was 4 to 5 mm in 40% of cases, 6 to 7 mm in 28% of cases, 8 to 10 mm in 21% of cases, and > 10 mm in 11% of cases. The median age at the final follow-up evaluation was 4.5 years (range: 6.8 months to 16.2 years). Thirty-four percent of atrial septal defects showed spontaneous closure, and 28% decreased to a diameter of < or = 3 mm. Logistic regression analysis revealed atrial septal defect diameter and age at diagnosis as independent predictors of spontaneous closure or regression to < or = 3-mm defect size. Of atrial septal defects with a diameter of 4 to 5 mm at diagnosis, 56% showed spontaneous closure, 30% regressed to a diameter of < or = 3 mm, and none required surgical closure. Of atrial septal defects with a diameter of > 10 mm at diagnosis, none closed spontaneously, whereas 77% required surgical or device closure. Gender and observation time were not associated with spontaneous atrial septal defect closure or regression to < or = 3 mm.
Conclusions:
In the present study population of children with atrial septal defects, 62% showed spontaneous closure (34%) or regression to < or = 3 mm (28%). Initial atrial septal defect diameter was the main predictor of spontaneous closure.
