Authors
1 Pediatric Cardiologist, Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan 9816743111, Iran.
2 M.Phil, PhD in Demography, Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan 9816743111, Iran.
Abstract
Background
Atrial septal defects (ASDs) are the most common third congenital heart defects. This study aimed to evaluate the clinical course of ASDs and the relationship between its complications, location closure and size.
Materials and Methods: This cross-sectional study was conducted in the cardiac center of the pediatric ward in Zahedan, Iran. The study was carried out on 529 children with ASD between 2003 and 2018. The ASD children underwent echocardiography and complete examination such as physical exams, ECG and chest X-ray at every visit during follow-up. A diagnosis of ASDs was confirmed by a transthoracic echocardiography. A unique cardiologist applied transthoracic echocardiography to get information about size, location, and the number of the defects as well as hemodynamic information such as pulmonary artery pressure and any associated lesions. The data were analyzed using SPSS software version 20.0.
Results: From 529 ASD children, 278 (52.5%) were girls. Most were medium (46.1%). 44.2% were closed by surgery; about 90.9% were secundum. 133 closed spontaneously and 14.6% by device. ASDs size had significant association with closure, location, and complication (P<0.001). The sinus venosus occurred in 29 patients, of which 62.07% and 37.93% were medium and large, respectively. PH was observed in nine children, 88.89% were large. ASD closure had significant association with location, and complication (P<0.001). From secundums, surgery and occluder devices closed 40.75% and 15.80, respectively. From those closed by surgery, 8.12% had residuals, 10.26% were partial anomalous pulmonary venous connection (PAPVC) as comorbidities, and 3.42% had pulmonary hypertension.
Conclusion: From the study concluded ASDs size had significant association with closure, location, and complication and ASDs closure had significant association with location and complication.
Keywords
- Tal Geva, Jose D Martins, Rachel M Wald, Atrial septal defects. Lancet 2014; 383: 1921–32
- van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7.
- Amel-Shahbaz S, Behjati-Ardakani M, Namayandeh SM, Vafaeenasab M, Andishmand A, Moghimi S, et al. The epidemiological aspects of congenital heart disease in central and southern district of Iran. Adv Biomed Res. 2014;3:233. doi: 10.4103/2277-9175.145732.
- Chelu RG, Horowitz M, Sucha D, Kardys I, Ingremeau D, Vasanawala S, Nieman K, Paul JF, Hsiao A. Evaluation of atrial septal defects with 4D flow MRI-multilevel and inter-reader reproducibility for quantification of shunt severity. 2018 Aug 31;
- Gatzoulis MA, Alonso-Gonzalez R, Beghetti M. Pulmonary arterial hypertension in paediatric and adult patients with congenital heart disease. European Resp Rev 2009;18:154–161.
- Behjati-Ardakani M, Golshan M, Akhavan-Karbasi S, Hosseini SM, Behjati-Ardakani MA, Sarebanhassanabadi M. The clinical course of patients with atrial septal defects. Iranian journal of pediatrics. 2016 Aug;26(4).
- Tanghöj G, Odermarsky M, Naumburg E, Liuba P. Early complications after percutaneous closure of atrial septal defect in infants with procedural weight less than 15 kg. Pediatric cardiology. 2017 Feb 1;38(2):255-63
8. Nashat H, Montanaro C, Li W, Kempny A, Wort SJ, Dimopoulos K, Gatzoulis MA, Babu-Narayan SV. Atrial septal defects and pulmonary arterial hypertension. Journal of thoracic disease. 2018 Sep;10(Suppl 24):S2953.
- Refaei M, Islam S, Mackie AS, Atallah J. Correlation of electrocardiogram parameters and hemodynamic outcomes in patients with isolated secundum atrial septal defects. Annals of pediatric cardiology. 2017 May;10(2):152.
- 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 Mar 1;87(3):256-9.
11. Fiszer R, Szkutnik M, Chodór B, Białkowski J. Spontaneous closure of a large atrial septal defect in an infant. Postepy Kardiol Interwencyjnej. 2014;10(4):264-6.12. Saito T, Ohta K, Nakayama Y, Hashida Y, Maeda A, Maruhashi K, Yachie A. Natural history of medium-sized atrial septal defect in pediatric cases. Journal of cardiology. 2012 Sep 1;60(3):248-51.
- Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics. 2006;118(4):1560–5. doi: 10.1542/peds.2005-3037.
- Rossi RI, Cardoso Cde O, Machado PR, et al. Transcatheter closure of atrial septal defect with Amplatzer device in children aged less than 10 years old: immediate and late follow-up. Catheter Cardiovasc Interv 2008;71:231–6
- Rastegari M, Redington A, Sullivan ID. Influence of the introduction of Amplatzer device on the interventional closure of defects within the oval fossa in children. Cardiol Young 2001;11:521–5.
- Vogel M, Berger F, Dahnert I, Ewert P, Lange PE. Treatment of atrial septal defects in symptomatic children aged less than 2 years of age using the Amplatzer septal occluder. Cardiol Young 2001;10: 534 –7.
- Butera G, Biondi-Zoccai G, Sangiorgi G, Abella R, Giamberti A, Bussadori C, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and metaanalysis of currently available clinical evidence. EuroIntervention 2011; 7: 377 – 385.
18. Farooqi M, Stickley J, Dhillon R, Barron DJ, Stumper O, Jones TJ, Clift PF, Brawn WJ, Drury NE. Trends in surgical and catheter interventions for isolated congenital shunt lesions in the UK and Ireland. Heart. 2019 Jul 1;105(14):1103-8.
- Moore J, Hegde S, El-Said H, Beekman R 3rd, Benson L, Bergersen L, Holzer R, Jenkins K, Ringel R, Rome J, Vincent R, Martin G; ACC IMPACT Steering Committee. Transcatheter device closure of atrial septal defects: a safety review. JACC Cardiovasc Interv 2013;6:433–442.
20. Werner RS, Prêtre R, Maisano F, Wilhelm MJ. Fracture of a Transcatheter Atrial Septal Defect Occluder Device Causing Mitral Valve Perforation. The Annals of thoracic surgery. 2019 Jul 1;108(1):e29-30.
- Kodaira M, Kawamura A, Okamoto K, Kanazawa H, Minakata Y, Murata M, Shimizu H, Fukuda K. Comparison of clinical outcomes after transcatheter vs. minimally invasive cardiac surgery closure for atrial septal defect. Circulation Journal. 2017:CJ-16