Atrial septal defects in neonates with reference to spontaneous closure

doi:10.1016/0002-8703(88)90259-1

American Heart Journal

Volume 116, Issue 1, Part 1, July 1988, Pages 123-127

https://doi.org/10.1016/0002-8703(88)90259-1 Get rights and content

Abstract

Early diagnosis of atrial septal defects (ASDs) by means of two-dimensional echocardiography has facilitated studies on the natural course of this lesion. Among 12 Japanese infants in whom a diagnosis of opening of the atrial septum was made in the neonatal period, eight had spontaneous closure at age 2 to 16 months, as shown by two-dimensional echocardiography. To study the exact incidence and natural course of atrial openings in the neonatal period, another 102 consecutive infants from two neonatal care units were followed prospectively with the use of two-dimensional echocardiography. Atrial openings were evident in 24 infants (24%) within the first week of life, in 13 (13%) older than 1 week, in seven (7%) older than 1 month, in five (5%) older than 6 months, and in two (2%) older than 1 year. Twenty-eight of the 30 infants with spontaneous closure in both groups had valvellke openings of the atrial septum that closed by fusion of the valves. ASDs that closed spontaneously in infants with clinical signs and symptoms of atrial shunt may be the same clinical entity as the valvelike openings of the atrial septum frequently observed in neonates with few clinical symptoms and may be differentiated morphologically from ASDs with openings without valve formation, which have little tendency to close.

References (14)

RP Ghisla et al.
Spontaneous closure of isolated secundum atrial septal defects in infants: an echocardiographic study
Am Heart J
(1985)
MR Mody
Serial hemodynamic observations in secundum atrial septal defect with special reference to spontaneous closure
Am J Cardiol
(1973)
RH Anderson et al.
Mechanisms of closure of perimembranous ventricular septal defect
Am J Cardiol
(1983)
JT Cockerman et al.
Spontaneous closure of secundum atrial septal defect in infants and young children
Am J Cardiol
(1983)
FF Nakamura et al.
Atrial septal defect in infants
Pediatrics
(1964)
AM Rudolph
Congenital diseases of the heart
AM Rudolph et al.
Patent ductus arteriosus: a clinical and hemodynamic study of 23 patients in the first year of life
Pediatrics
(1958)

There are more references available in the full text version of this article.

Cited by (55)

Congenital Heart Disease: A Clinical, Pathological, Embryological, and Segmental Analysis
2022, Congenital Heart Disease: A Clinical, Pathological, Embryological, and Segmental Analysis
Feasibility of Transcatheter Closure of Secundum Atrial Septal Defect in Low Weight Infants Under 2-Year-Old from a 3-year Retrospective Cohort Study
2020, American Journal of Cardiology
We aimed to evaluate the feasibility of interventional treatment of atrial septal defect (ASD) in low weight infants under 2-year-old. Seven hundred and ninety-three secundum ASD patients were divided into 2 groups: 665 were above 2-year-old and 128 were under 2-year-old. The basic conditions before the operation, postoperative complications within 24 hours, and adverse outcomes during a three-year follow-up were compared between the 2 groups using multivariate analysis. There were significant differences in age, weight, and the diameter of the ASD between the 2 groups (p <0.001). The immediate success rate of the procedure was 96.7%. There were no significant differences in the success rate of the procedure, the incidence of residual shunt, arrhythmia, procedure-related arrhythmia, and occluder shedding between 2 groups (p >0.05). Similarly, we found no association between age ≤2-year-old and any adverse outcomes postprocedure within 24 hours, including procedure failure (OR = 0.35; 95%CI: 0.04 to 2.93), residual shunt (OR = 1.07; 95%CI: 0.54 to 2.14), arrhythmia (OR = 0.68; 95%CI: 0.32 to 1.43), or procedure-related arrhythmia (OR = 0.34; 95%CI: 0.04 to 2.87). In the follow-up data, we found no association between age ≤2-year-old and arrhythmia (HR = 0.95; 95%CI: 0.50 to 1.80) and procedure-related arrhythmia (HR = 0.96;95%CI:0.25 to 3.64). Kaplan-Meier survival curves indicated no significant difference in the occurrence of arrhythmia between the 2 groups (log-rank test: p = 0.776). In conclusion, percutaneous ASD closure in young and low weight infants has a high success and low complication rate, along with reliable effects.
Device closure of secundum atrial septal defects in children <15 kg: Complication rates and indications for referral
2012, JACC: Cardiovascular Interventions
Citation Excerpt :
Historically, the recommendation for elective ASD closure from surgical literature was to wait until around 4 years of age (9). Numerous previous studies have shown a fairly high rate of spontaneous closure of ASD <8 mm in the first few years of life (10–13), and rarely as late as adolescence (14). Due to the known high rates of spontaneous closure in the first year of life, it has been written, “One should be careful about proceeding too rapidly to close an ASD in an asymptomatic young patient” (15).
This study sought to determine institutional complication rates in a previously underreported patient population and discuss referral indications.
There has been a trend over the years for referral of younger and smaller patients for “elective” closure of atrial septal defects (ASD). In general, the risks associated with ASD device closure are believed and reported to be relatively low. Complication rates in this group of smaller patients are not well described in the literature for either percutaneous or surgical approaches.
Retrospective review of all patients who underwent elective transcatheter closure of secundum ASD between March 2000 and April 2010. We excluded all children >15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated.
We identified 128 patients meeting criteria with a median procedural age of 1.92 years (3 months to 4.92 years), and median weight of 10.8 kg (4.3 to 14.9 kb). There were 7 major (5.5%) and 12 minor (9.4%) complications. Nearly two-thirds of referrals were for right heart enlargement or poor growth. Rate of resolution of residual shunt was 99%. When compared with age, there was no difference in the rate of resolution of right heart enlargement. No clinically significant improvement in growth was observed.
Transcatheter ASD closure in small children is highly successful, but with an increase in previously perceived complication rates. In small, asymptomatic patients, deferral of closure until the historically established timeline of around 4 to 5 years of age should be strongly considered.
Interatrial communications
2010, Paediatric Cardiology
Interatrial Communications
2009, Paediatric Cardiology
A Follow-up Study of Neonatal Interatrial Shunt with Echocardiography until Twelve to Fifteen Months of Age
2008, Pediatrics and Neonatology
To assess the incidence and natural history of full-term neonates with interatrial shunt (IAS).
A follow-up study of 1389 neonates who received screening echocardiography between 2003 and 2006. Babies with IAS at 2 to 4 days of life underwent follow-up echocardiography at 2 to 4 months, 6 to 9 months and 12 to 15 months of age until closure of IAS.
The ratio of IAS was 68.3% initially. No significant demographic differences were identified between infants with and without initial IAS. Among 949 neonates with initial IAS, 84.5% infants had a left-to-right interatrial shunt, 13.5% had bidirectional shunt and 2% had predominantly right-to-left shunt. The persistence rate of IAS at 12 to 15 months of age was 3.8% (44/1166). The initial size of IAS ranged from 1.2 to 7.7 mm (4.3 ± 1.1 mm) detected by color Doppler flow mapping and cases were divided into three groups: small (≦5 mm), medium (5 to 8 mm) and large group (≧8 mm). There were 74.6% infants in the small group and 25.4% in the medium group initially. The neonates in the initial small group would always see their IAS close or else they would remain in the small group. Those in the final medium and large size groups always came from the initial medium group. The late closure rate of IAS was 93.9% of infants with initial IAS. The closure curves of initial small and medium sized groups were significantly different, and their late closure rates were 95.1% and 90.4%, respectively.
IAS was very common during early neonatal stage, but most cases would close after 1 year. The late closure rate of initial IAS was different if using a cutpoint of 5 mm.

View all citing articles on Scopus

^☆: Supported in part by a grant for neonatal and child health research from the Ministry of Health and Welfare of Japan.

View full text

Atrial septal defects in neonates with reference to spontaneous closure☆

Abstract

Am Heart J

Am J Cardiol

Am J Cardiol

Spontaneous closure of secundum atrial septal defect in infants and young children

Am J Cardiol

Atrial septal defect in infants

Pediatrics

Congenital diseases of the heart

Patent ductus arteriosus: a clinical and hemodynamic study of 23 patients in the first year of life

Pediatrics