Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-26T20:43:03.037Z Has data issue: false hasContentIssue false
  • English
  • Français

Spontaneous closure of atrial septal defects within the oval fossa

Published online by Cambridge University Press:  20 January 2005

Nawal Azhari ,
Mohammad S. Shihata  and
Abdulelah Al-Fatani
Nawal Azhari
Affiliation:
Department of Pediatric Cardiology, Maternity and Children Hospital, Jeddah, Saudi Arabia
Mohammad S. Shihata
Affiliation:
Department of Pediatric Cardiology, Maternity and Children Hospital, Jeddah, Saudi Arabia
Abdulelah Al-Fatani
Affiliation:
Department of Pediatric Cardiology, Maternity and Children Hospital, Jeddah, Saudi Arabia
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To estimate the incidence and timing of spontaneous closure of atrial septal defects within the oval fossa, to study the modalities for diagnosis, and predict the need for therapeutic intervention. Methods: We reviewed retrospectively the medical records of patients with isolated atrial septal defects within the oval fossa, so-called “secundum defects”, diagnosed between January 1990 and February 2003. Based on the initial echocardiographic evaluation, we divided defects into small ones measuring from 3 to 5 mm, medium ones from 5 to 8 mm, and large ones greater than 8 mm. Results: We identified 121 patients, 50 (41.3%) of whom had failed to thrive, and 14 (11.6%) had congestive heart failure. At a mean of 44.9 ± 22.1 months following diagnosis, with a range from 12 to 102 months, the defects had closed spontaneously in 31 patients (25.6%). Of 22 patients having small defects, spontaneous closure occurred in 18 (82%) at a mean age of 18.9 ± 10.2 months. Of 27 patients with defects of medium size, 12 (44%) either experienced spontaneous closure, or else the defect effectively became a patent oval foramen, at a mean age of 51.2 ± 32.2 months. Only 1 (1.4%) of the 72 patients with a defect larger than 8 mm in size underwent spontaneous closure. The defects increased in size in 8 patients (6.6%). Intervention was necessary in 76 patients (63%) at a mean age of 75.5 ± 15.2 months. Conclusion: The initial size of a defect within the oval fossa at diagnosis is the best predictor of its natural history. Some defects increase in size with growth, irrespective of their initial size.

Keywords

Interatrial septal defectspontaneous closurevolume overload
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 2 , April 2004 , pp. 148 - 155
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beerman LB, Zuberbuhler JR. Atrial septal defect. In: Anderson RH, Macartney FJ, Shinebourne EA, Tynan M (eds). Paediatric Cardiology. Churchill Livingstone, Edinburgh, 1987, pp 541.
Hoffman JIE, Rudolph AM, Danilowicz D. Left to right atrial shunts in infants. Am J Cardiol 1972; 30: 868–875.Google Scholar
Hunt CE, Lucas RV. Symptomatic atrial septal defect in infancy. Circulation 1973; 47: 1042–1048.Google Scholar
Dimich I, Steinfeld L, Park SC. Symptomatic atrial septal defect in infants. Am Heart J 1973; 85: 601–604.Google Scholar
Toews WH, Nora JJ, Wolfe RR. Presentation of atrial septal defect in infancy. JAMA 1975; 234: 1250–1251.Google Scholar
McMahon CJ, Feltes TF, Fraley JK, Bricker JT, Grifka RG, Tortoriello TA, Blake R, Bezold LI. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 2002; 87: 256–259.Google Scholar
Helgason H, Jonsdottir G. Spontaneous closure of atrial septal defects. Pediatr Cardiol 1999; 20: 195–199.Google Scholar
Timmis GC, Gordon S, Reed JO. Spontaneous closure of an atrial septal defect. JAMA 1966; 196: 137–139.Google Scholar
Hartmann AF Jr, Elliott LP. Spontaneous physiologic closure of an atrial septal defect after infancy. Am J Cardiol 1967; 19: 290–292.Google Scholar
Mody MR. Serial hemodynamic observations in secundum atrial septal defect with special reference to spontaneous closure. Am J Cardiol 1973; 32: 978–981.Google Scholar
Brassard M, Fouron JC, van Doesburg N, Mercier LA, De Guise P. Outcome of children with atrial septal defect considered too small for surgical closure. Am J Cardiol 1999; 83: 1552–1555.Google Scholar
Radzik D, Davignon A, van Doesburg N, Fournier A, Marchand T, Ducharme G. Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life. J Am Coll Cardiol 1993; 22: 851–853.Google Scholar
Roge CL, Silverman NH, Hart PA, Ray RM. Cardiac structure growth pattern determined by echocardiography. Circulation 1978; 57: 285–290.Google Scholar
Mahoney LT, Truesdell SC, Krzmarzick TR, Lauer RM. Atrial septal defects that present in infancy. AJDC 1986; 140: 1115–1118.Google Scholar
Hastreiter AR, Wennemark JR, Miller RA. Secundum atrial septal defects with congestive heart failure during infancy and early childhood. Am Heart J 1962; 64: 467–472.Google Scholar
Nakamura FF, Hauck AJ, Nadas AS. Atrial septal defect in infants. Pediatrics 1964; 34: 101–106.Google Scholar
Ainger LE, Page JW. Ostium secundum atrial septal defects and congestive heart failure in infancy. Am J Cardiol 1965; 15: 380–385.Google Scholar
Weinberg M, Miller RA, Hastreiter AR. Congestive heart failure in children with atrial septal defect. J Thorac Cardiovasc Surg 1966; 51: 81–87.Google Scholar
Kavanagh-Gray D. Atrial septal defect in infancy. Can Med Assoc J 1963; 89: 491–499.Google Scholar
Ghisla RP, Hannon DW, Meyer RA, Kaplan S. Spontaneous closure of isolated secundum atrial septal defects in infants: an echocardiographic study. Am Heart J 1985; 109: 1327–1333.Google Scholar
Fukazawa M, Fukushige J, Ueda K. Atrial septal defects in neonates with reference to spontaneous closure. Am Heart J 1988; 116: 123–127.Google Scholar
Cockerham JT, Martin TC, Gutierrez FR, Hartmann AF, Goldring D, Strauss AW. Spontaneous closure of secundum atrial septal defect in infants and young children. Am J Cardiol 1983; 52: 1267–1271.Google Scholar
Craig RJ, Selzer A. Natural history and prognosis of atrial septal defect. Circulation 1968; 37: 805–815.Google Scholar
Kirklin JW, Barratt-Boyes BG. Cardiac Surgery, 2nd edn. Churchill Livingstone, Edinburgh, 1993, pp 609–644.
Porter CJ, Feldt RH, Edward WD, Seward JB, Schaff HV. Atrial Septal Defect. In: Moss AJ, Adams FH (eds). Heart Disease in Infants, Children, and Adolescents Including the Fetus and Young Adults, 5th edn. Williams and Wilkins, Baltimore, 1995, pp 687.