Related Experiment Video
Updated: Mar 28, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Echocardiographic Reference Values for Right Atrial Size in Children with and without Atrial Septal Defects or
Martin Koestenberger1, Ante Burmas2, William Ravekes3
1Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria. martin.koestenberger@medunigraz.at.
Insights
Right atrial size measurements are valuable for diagnosing congenital heart disease (CHD) in children. Enlarged right atrial dimensions accurately predict conditions like atrial septal defect (ASD) and pulmonary hypertension (PH-CHD).
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Right atrial (RA) size is a potentially useful echocardiographic measure in children with right-heart dysfunction due to congenital heart disease (CHD).
- Limited studies exist on growth-related changes in RA dimensions and its predictive value in pediatric populations with specific CHD conditions.
Purpose of the Study:
- To investigate growth-related changes in RA dimensions in healthy children.
- To determine the predictive value of RA size variables for secundum atrial septal defect (ASD) and pulmonary hypertension secondary to CHD (PH-CHD) in pediatric patients.
Main Methods:
- Prospective study involving 516 healthy children, 80 with secundum ASD, and 42 with PH-CHD.
- Measured RA end-systolic major-axis length, minor-axis length, and area, stratified by age, weight, length, and body surface area.
- Established normal RA size values (z scores -2 to +2) and determined predictive cutoff scores using the Youden Index.
Main Results:
- RA end-systolic length and area z scores were significantly increased in children with ASD and PH-CHD compared to healthy controls.
- Enlarged RA variables (z scores >+2) demonstrated high sensitivity and specificity in predicting both secundum ASD (up to 94% sensitivity, 91% specificity) and PH-CHD (up to 98% sensitivity, 94% specificity).
Conclusions:
- Provides normative data for RA size and area in a large pediatric cohort.
- Two-dimensional echocardiographic assessment of RA size is effective in identifying right atrial enlargement in pediatric patients with high volume load (ASD) or pressure load (PH-CHD).
- Enlarged RA dimensions serve as a reliable indicator for diagnosing secundum ASD and PH-CHD in children.
Abstract:
Right atrial (RA) size may become a very useful, easily obtainable, echocardiographic variable in patients with congenital heart disease (CHD) with right-heart dysfunction; however, according studies in children are lacking. We investigated growth-related changes of RA dimensions in healthy children. Moreover, we determined the predictive value of RA variables in both children with secundum atrial septal defect (ASD) and children with pulmonary hypertension (PH) secondary to CHD (PH-CHD). This is a prospective study in 516 healthy children, in 80 children with a secundum ASD (>7 mm superior-inferior dimension), and in 42 children with PH-CHD. We determined three RA variables, i.e., end-systolic major-axis length, end-systolic minor-axis length, and end-systolic area, stratified by age, body weight, length, and surface area. RA end-systolic length and area z scores were increased in children with ASD and PH-CHD when compared to those variables in the healthy control population. Using the Youden Index to determine the best cutoff scores in sex- and age-specific RA dimensions, we observed a sensitivity and specificity up to 94 and 91 %, respectively, in ASD children and 98 and 94 %, respectively, in PH-CHD children. We provide normal values (z scores -2 to +2) for RA size and area in a representative, large pediatric cohort. Enlarged RA variables with scores >+2 were predictive of secundum ASD and PH-CHD. Two-dimensional determination of RA size can identify enlarged RAs in the setting of high volume load (ASD) or pressure load (PH-CHD).
More Related Videos
Related Concept Videos
01:21Cardiac Catheterization II: Right Heart Catheterization
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests