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Natural history of growth of secundum atrial septal defects and implications for transcatheter closure
  1. C J McMahon1,
  2. T F Feltes2,
  3. J K Fraley3,
  4. J T Bricker1,
  5. R G Grifka1,
  6. T A Tortoriello1,
  7. R Blake1,
  8. L I Bezold1
  1. 1The LillieFrank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, 6621 Fannin, Texas 77030, USA
  2. 2Department of Pediatric Cardiology 700 Children's Drive, Columbus, Ohio 43205, USA
  3. 3Department of Biostatistics, Children's Nutrition Research Center, Houston, Texas, USA
  1. Correspondence to:
    Dr Colin McMahon, LillieFrank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin, MC-2280 Houston, Texas 77030, USA;


Objective: To investigate the natural history of secundum atrial septal defects (ASDs) over several years using serial echocardiographic studies.

Methods: All patients with isolated secundum ASDs who had serial transthoracic echocardiograms at Texas Children's Hospital, Houston, Texas, from January 1991 to December 1998 were identified. Patients with fenestrated or multiple ASDs, other congenital heart defects, or less than a six month interval between echocardiograms were excluded. There were 104 patients eligible for inclusion in the study. Studies were reviewed by two echocardiographers (blinded) and the maximal diameter was recorded. Defects were defined as small (> 3 mm to < 6 mm), moderate (≥ 6 mm to < 12 mm), or large (≥ 12 mm). ASDs that grew ≥ 20 mm were defined as having outgrown transcatheter closure with the device available to the authors' institution.

Results: ASD diameter increased in 68 of 104 patients (65%), including 31 patients (30%) with a > 50% increase in diameter. Spontaneous closure occurred in four patients (4%). Thirteen defects (12%) increased to ≥ 20 mm. One fifth of the patients studied had an insufficient atrial rim by transthoracic echocardiogram to hold an atrial septal occluder. The only factor associated with significant growth of ASDs was initial size of the defect. ASD growth was independent both of age at diagnosis and when indexed to body surface area.

Conclusions: Two thirds of secundum ASDs may enlarge with time and there is the potential for secundum ASDs to outgrow transcatheter closure with specific devices. Further development in devices and general availability of devices capable of closing larger ASDs should circumvent this problem.

  • atrial septal defect
  • natural history
  • transcatheter closure

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  • Dr McMahon is supported by an Abercrombie Grant from the Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA.

  • Presented at the 73rd Scientific Sessions of the American Heart Association, New Orleans, Louisiana, USA, 12–15 November 2000.