Natural history of medium-sized atrial septal defect in pediatric cases.
BACKGROUND
The indication for surgical repair of atrial septal defect (ASD) is pulmonary to systemic blood flow ratio (Qp/Qs)>2.0, and therapeutic strategy depends on the facility in cases of Qp/Qs 1.5-2.0. Defect size increases with age, but hemodynamic changes of medium-sized ASD (Qp/Qs 1.5-2.0) are unknown.


RESULTS
From April 1, 1985 to March 31, 2008, we experienced 125 cases of cardiac catheterization for ASD. Twelve cases were re-evaluated without surgical repair. The first and second catheterizations were performed at median ages of 7 years (range, 2-13 years) and 16 years (range, 5-19 years), respectively. The mean follow-up period was 7 years. Qp/Qs increased from 1.6 to 2.0 during follow-up (p<0.05). Of four cases with Qp/Qs<1.5 at initial presentation, three had Qp/Qs≥1.5 at second inspection. Right ventricle diastolic volume (RVEDV/LVEDV) also increased.


CONCLUSIONS
Qp/Qs and RVEDV/LVEDV of medium-sized ASD increase together in childhood. Re-evaluation before adulthood should be considered in patients with no indications of ASD closure in childhood.
Department of Pediatrics, Angiogenesis and Vascular Development, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Takekatsu
T
Saito
Kunio
K
Ohta
Yuko
Y
Nakayama
Yoko
Y
Hashida
Akiko
A
Maeda
Keiko
K
Maruhashi
Akihiro
A
Yachie
D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D055815:Young Adult