Presentation of Atrial Septal Defect in the Pediatric Population

Abstract

Our recent experience indicates that patients with a hemodynamically significant atrial septal defect secundum (ASD2) do not necessarily present with classic physical and electrocardiographic (ECG) findings. The purpose of the study was to review the records of patients either receiving a catheter device or undergoing surgical repair for the closure of ASD2 to determine their initial physical and ECG findings. Therefore, we did a retrospective review of 47 consecutive patients who had echocardiographic evidence of a hemodynamically significant isolated ASD2 and who underwent ASD2 closure. Of these 47 patients, the presenting complaints were murmur (n = 36), chest pain (n = 6), seizure (n = 1), stroke (n = 1), syncope (n = 1), Kawasaki's disease (n = 1), and cardiomegaly (n = 1). Charts were reviewed for the evaluation of four abnormal physical findings: hyperactive right ventricular impulse, split fixed second heart sound, systolic and diastolic flow murmurs; and three ECG abnormalities: right axis deviation, right atrial enlargement, and evidence of right ventricular hypertrophy. In all, 30% of patients had either one or no typical physical findings, 18% had normal ECG findings, and 7% had no physical or ECG findings. On physical examination and ECG, the abnormalities due to ASD2 may be too subtle to detect. Although it is well known that variations can occur in the clinical signs and symptoms typical of ASD2, dependence on classical physical and or ECG findings may result in the underdiagnosis of a significant number of patients.

Clinical Characteristics and Outcome of Incidental Atrial Septal Openings in Very Low Birth Weight Infants

“…Most ASDs were traditionally diagnosed based on symptoms such as heart murmur, cardiomegaly and chest pain [2]; however, in modern practice, echocardiography is frequently used as a tool in neonatal units to evaluate respiratory problems or cardiomegaly and to examine benign murmurs in otherwise healthy babies. Notably, however, this use of echocardiography has also led to the incidental discovery of ASDs.…”

Prognosis for Pediatric Patients with Isolated Atrial Septal Defect

“…Christensen et al evaluated 47 patients whose median defect diameter was 13 mm and detected normal ECG findings in only 18% of cases. [10] Azhari et al detected right ventricular conduction delay in 88% of 121 patients, and demonstrated increases in right ventricular and atrial load on ECG in parallel with increase in defect diameter. [11] Outcomes of present study were similar to those in the literature.…”

Correlation of electrocardiogram parameters and hemodynamic outcomes in patients with isolated secundum atrial septal defects

“…[14] They reported similar median age of patients to our study (at last follow-up), however, used different ASD size ranges. The remaining studies included either smaller patient cohorts of 20–47 patients with an older mean age of 7.7 years[121317] and/or included a select patient population referred for ASD closure. [131417] In the study by Schiller et al ., the reported RSR’ prevalence combined RSr’, rSR’, and QR patterns in lead V1.…”

“…[121314151617] This pattern is rarely described in normal patients as well. This rSR’ pattern is hypothesized to correlate with RV enlargement rather than a conduction disturbance.…”