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Correction of isolated secundum atrial septal defect in infancy
Insights
Secundum atrial septal defect (ASD) rarely occurs in infancy. This study highlights surgical intervention for infants with intractable heart failure due to ASD, challenging typical management for this congenital heart defect.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Pediatric Cardiac Surgery
Background:
- Secundum atrial septal defect (ASD) is a common congenital heart lesion but rarely presents symptomatically in infancy.
- The natural history of ASD is generally benign, with conservative management often recommended until school age.
- Limited data exists on surgical indications for ASD in infancy.
Purpose of the Study:
- To present the experience of surgical intervention in infants with isolated secundum ASD.
- To describe the diagnostic and management challenges associated with infantile ASD presentations.
- To highlight the need for considering surgery in infants with intractable heart failure due to ASD.
Main Methods:
- Retrospective review of 6 pediatric patients.
- Analysis of patients who underwent surgery for isolated secundum ASD within the first year of life.
- Evaluation of patients who failed conservative management for heart failure.
Main Results:
- Six infants required surgical intervention for intractable heart failure due to isolated secundum ASD.
- Patient presentations and physical signs were atypical compared to older children with ASD.
- Diagnosis and management posed significant challenges due to the atypical presentation.
Conclusions:
- Infantile presentation of secundum ASD can lead to intractable heart failure requiring early surgical intervention.
- Atypical clinical signs in infants necessitate careful diagnostic evaluation for ASD.
- Early surgical consideration is crucial for infants with severe heart failure secondary to ASD unresponsive to conservative measures.
Abstract:
Although it is a common congenital cardiac lesion, secundum atrial septal defect (ASD) rarely presents in infancy. Its natural history in the first two decades of life is generally benign. Reports of symptomatic ASD in early childhood stress the place of conservative management, and recommend that the operation should be deferred until school age. Few accounts of the indications for surgery in infancy exist. We present our experience of 6 patients who failed to respond adequately to conservative treatment and required operation for intractable heart failure due to isolated secundum ASD in the first year of life. As their presentation and physical signs were not typical of ASD seen in later childhood, they presented problems both of diagnosis and management.