A novel algorithm for classification of interatrial communications within the oval fossa in the newborn

Abstract

Background: An interatrial communication is present in most neonates. The majority are considered the “normal” patency of the oval foramen, while a minority are abnormal atrial septal defects. Differentiation between the two with transthoracic echocardiography may be challenging, and no generally accepted method of classification is presently available. We aimed to develop and determine the reliability of a new classification of interatrial communications in newborns. Methods and Results: An algorithm was developed based on echocardiographic criteria from 495 newborns (median age 11[8;13] days, 51.5% females). The algorithm defines three main categories: patency of the oval foramen, atrial septal defect, and no interatrial communication as well as several subtypes. We found an interatrial communication in 414 (83.6%) newborns. Of these, 386 (93.2%) were categorised as patency of the oval foramen and 28 (6.8%) as atrial septal defects. Echocardiograms from another 50 newborns (median age 11[8;13] days, 36.0% female), reviewed by eight experts in paediatric echocardiography, were used to assess the inter- and intraobserver variation of classification of interatrial communications into patency of the oval foramen and atrial septal defect, with and without the use of the algorithm. Review with the algorithm gave a substantial interobserver agreement (kappa = 0.66), and an almost perfect intraobserver agreement (kappa = 0.82). Without the use of the algorithm, the interobserver agreement between experienced paediatric cardiologists was low (kappa = 0.20). Conclusion: A new algorithm for echocardiographic classification of interatrial communications in newborns produced almost perfect intraobserver and substantial interobserver agreement. The algorithm may prove useful in both research and clinical practice.

A Hemoglobin Variant Causing an Unexplained Low Oxygen Saturation by Pulse Oximetry: Two Case Reports

“…Interatrial communication is present in most neonates, mostly due to patent foramen ovale and in a minority due to a true atrial septal defect of “the ostium secundum” type [ 10 ]. As case number one had an exclusive left-to-right shunt, it could not be responsible for low oxygen saturation.…”

Electrocardiographic Characteristics in 438 Neonates with Atrial Septal Defects

“…Details about the cohort profile for the Copenhagen Baby Heart Study and data obtained in the study are described in a previous publication [ 17 ]. We included neonates from CBHS where the TTE included visualization of the atrial septum in 2D with and without color Doppler and with adequate image quality to determine the presence or absence of an ASD [ 18 ]. We excluded neonates with concomitant major cardiac malformations, neonates with syndromes, and neonates where no ECG was obtained or where the cardiac examination (TTE and ECG) was performed more than 30 days after birth.…”

“…Echocardiograms were stored and analyzed using EchoPAC software (GE Healthcare, Horten, Norway). Echocardiograms were individually and systematically assessed for secundum-type ASDs by physicians trained in pediatric echocardiography using a novel algorithm for the assessment of interatrial communications in the oval fossa that was developed and validated in the CBHS and has been described in detail previously [ 18 ]. Analyses were based on several echocardiographic criteria, where we defined neonates as having an ASD in cases where color Doppler flow was crossing the atrial septum and 2D cross-sectional images showed either multiple visible communications (fenestrated ASD) or one single visible communication with either a diameter of ≥ 4 mm or a location in the inferior part of the atrial septum.…”