title: Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study.
abstract: OBJECTIVE
  The goals were to assess the frequency of spontaneous closure of isolated secundum atrial septal defect in children and to identify predictors of spontaneous atrial septal defect closure.
  
  
  METHODS
  A retrospective cohort study was performed in a tertiary care pediatric cardiology center. Consecutive patients (n = 200) diagnosed as having isolated atrial septal defects (no multiple or fenestrated atrial septal defects, no additional congenital heart disease, and no syndromes) were monitored for > 6 months with serial 2-dimensional echocardiography, according to a standardized protocol.
  
  
  RESULTS
  The median age at diagnosis was 5 months (minimum: 0 months; maximum: 13.9 years). The atrial septal defect diameter at diagnosis was 4 to 5 mm in 40% of cases, 6 to 7 mm in 28% of cases, 8 to 10 mm in 21% of cases, and > 10 mm in 11% of cases. The median age at the final follow-up evaluation was 4.5 years (range: 6.8 months to 16.2 years). Thirty-four percent of atrial septal defects showed spontaneous closure, and 28% decreased to a diameter of < or = 3 mm. Logistic regression analysis revealed atrial septal defect diameter and age at diagnosis as independent predictors of spontaneous closure or regression to < or = 3-mm defect size. Of atrial septal defects with a diameter of 4 to 5 mm at diagnosis, 56% showed spontaneous closure, 30% regressed to a diameter of < or = 3 mm, and none required surgical closure. Of atrial septal defects with a diameter of > 10 mm at diagnosis, none closed spontaneously, whereas 77% required surgical or device closure. Gender and observation time were not associated with spontaneous atrial septal defect closure or regression to < or = 3 mm.
  
  
  CONCLUSIONS
  In the present study population of children with atrial septal defects, 62% showed spontaneous closure (34%) or regression to < or = 3 mm (28%). Initial atrial septal defect diameter was the main predictor of spontaneous closure.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hanslik
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pospisil
authors.forename: Ulrike
authors.initials: U
authors.lastname: Salzer-Muhar
authors.forename: Susanne
authors.initials: S
authors.lastname: Greber-Platzer
authors.forename: Christoph
authors.initials: C
authors.lastname: Male
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012075:Remission, Spontaneous; D012189:Retrospective Studies