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Spontaneous closure of secundum atrial septal defect in infants and young children
Insights
Many pediatric patients with atrial septal defect (ASD) show symptoms, but some defects close spontaneously, especially in younger children. Early diagnosis and monitoring are key for managing ASD in children.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography and Cardiac Catheterization
Background:
- Ostium secundum atrial septal defect (ASD) is a common congenital heart condition in children.
- Symptoms like poor weight gain, pneumonia, cyanosis, and tachypnea can occur in pediatric patients with ASD.
- Infants with ASD may present with more severe symptoms, including congestive heart failure.
Purpose of the Study:
- To review records of pediatric patients with uncomplicated ostium secundum ASD.
- To analyze the incidence of spontaneous closure of ASD in young children.
- To compare hemodynamic data between ASDs that closed and those that did not.
Main Methods:
- Retrospective review of medical records for 264 pediatric patients diagnosed with ostium secundum ASD.
- Analysis of data from cardiac catheterization, including patient age, symptoms, and hemodynamic measurements.
- Comparison of spontaneous ASD closure rates and associated clinical and hemodynamic factors.
Main Results:
- 30% of pediatric patients exhibited symptoms such as poor weight gain, pneumonia, cyanosis, or tachypnea.
- 48% of infants (under 4 years) showed symptoms, with 33% experiencing congestive heart failure.
- Spontaneous closure of ASD was observed in 8 of 36 infants and 6 of 18 patients aged 1-2 years.
Conclusions:
- Spontaneous closure of ostium secundum ASD can occur in a significant proportion of young children.
- Hemodynamic data did not show significant differences between ASDs that closed and those that persisted in patients under 4 years.
- Patients with spontaneously closed ASDs differed significantly from those with a patent foramen ovale regarding age at study and atrial pressures.
Abstract:
The records of 264 pediatric patients with uncomplicated ostium secundum atrial septal defect (ASD) were reviewed. Eighty-seven patients were younger than age 4 years at the time of cardiac catheterization. Subnormal weight gain, frequent pneumonia, cyanosis or tachypnea were present in 26 patients (30%). Of the 36 infants at catheterization, 17 (48%) had the previously described symptoms, including 12 (33%) who had congestive heart failure. Eight of the 36 infants were found to have closed their defect at a subsequent catheterization. Six of 18 patients who underwent cardiac catheterization between 1 and 2 years of age also had spontaneously closed their ASD at subsequent study. Statistical analysis of hemodynamic data revealed no difference (except a smaller shunt size) between ASDs that closed and those that did not in patients who were less than 4 years at initial catheterization. Analysis of hemodynamic data revealed no statistical differences between groups of patients with an ASD who were younger than and those older than 4 years at time of diagnostic study. Patients with ASDs that closed were significantly different from patients with atrial level shunting thought to be secondary to a valve-incompetent foramen ovale with respect to age at initial study (11 versus 2 months, p less than 0.001), mean left atrial pressure (7.7 versus 12.3 mm Hg, p less than 0.02) and difference between mean right and left atrial pressures (1.0 versus 4.2 mm Hg, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)