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[Atrial septal defect symptomatic in infancy. Report of 11 cases (author's transl)]
Insights
This study reports on atrial septal defects in infants, finding similar symptoms to older patients. Early pulmonary vasodilatation may cause left-to-right shunting without increased pulmonary vascular resistance.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Context:
- Atrial septal defect (ASD), specifically ostium secundum, is a common congenital heart defect.
- Infants under one year with symptomatic ASD present unique diagnostic and management challenges.
- Understanding early hemodynamic changes in pediatric ASD is crucial for timely intervention.
Purpose:
- To describe the clinical presentation, associated anomalies, and hemodynamic characteristics of symptomatic atrial septal defects in infants under one year of age.
- To evaluate electrocardiographic (ECG) findings and surgical outcomes in this pediatric population.
- To explore the potential mechanisms behind early left-to-right shunting in young children with ASD.
Summary:
- Eleven infants under one year with symptomatic ostium secundum ASD were analyzed.
- Clinical presentation, extracardiac anomalies, pulmonary-to-systemic flow ratios (1.3-3.5), and ECG findings (including rare left ventricular enlargement and left anterior hemiblock in Noonan syndrome) were documented.
- Six patients underwent surgery between ages one and six, revealing large defects and normal pulmonary vascular resistances. Early pulmonary vascular bed vasodilatation is hypothesized as the cause of early shunting.
Impact:
- Highlights the importance of early diagnosis and intervention for symptomatic ASD in infants.
- Provides insights into the natural history and potential pathophysiology of congenital heart defects in early life.
- Informs clinical practice regarding the management of pediatric atrial septal defects and associated conditions.
Abstract:
Eleven cases of atrial septal defect, ostium secundum, with important symptomatology, under the age of one year are reported. The clinical picture does not differ essentially from what is found in older patients. Extracardiac associated anomalies are frequent. Pulmonary to systemic flow ratio varied between 1.3 and 3.5. The E.C.G. showed typical findings is most of the cases, but unexpected left ventricular enlargement was found in one case, and in another one with a Noonan syndrome, a left anterior hemiblock was present. Surgery was performed in six patients, between one and six years. In all, direct vision of the defect showed the large size of it. Pulmonary vascular resistances were normal. It is postulated that early vasodilatation of the pulmonary vascular bed could be the origin of the early onset of a left to right shunt in this patients without an increase in pulmonary vascular resistances.