Ostium Secundum Atrial Septal Defects Workup

  • Author: Ira H Gessner, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Dec 1, 2011
 

Laboratory Studies

  • No specific laboratory blood tests are necessary in the evaluation of patients with an ostium secundum atrial septal defect.
  • A small degree of right-to-left shunt may occur with a large atrial septal defect. This may be detected by observing a mild decrease in cutaneous oxygen saturation to 93-95%. Although this may increase hemoglobin and hematocrit minimally, it is insufficient to cause clinical cyanosis.
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Imaging Studies

  • Routine chest radiography is not essential in the evaluation of a child with a suspected secundum atrial septal defect. They demonstrate increased pulmonary arterial vascularity with a prominent pulmonic trunk, right atrial enlargement, no evidence of left atrial enlargement, and right ventricular dilation.
  • Echocardiography is essential in the evaluation of a child with a suspected atrial septal defect. The right atrium and right ventricle are dilated; paradoxical motion of the ventricular septum is usually present.
    • Two-dimensional imaging from the subcostal position best reveals the defect in the atrial septum. The diameter of the defect can be measured, multiple defects can be identified, and associated anomalies can be evaluated. Some investigators use 3-dimensional echocardiography to provide an accurate assessment of the exact shape of the defect because this can be important in device closure of atrial septal defects.
    • Color Doppler studies provide direct, simulated visualization of flow from the left atrium to the right atrium. This flow is not turbulent when the defect is large enough to be clinically apparent because its size eliminates the pressure difference between the atria.
    • Complete echocardiographic examination must also identify normality of the coronary sinus, normal entrance of the pulmonary veins, an intact primum portion of the atrial septum, and normal mitral valve function. Left ventricular contractility may appear abnormal due to the dilated right ventricle. This corrects rapidly after atrial septal defect closure.[12, 13, 14]
    • Transesophageal echocardiography may be necessary in some patients because of large body size or other impediments to adequate transthoracic visualization. Transesophageal echocardiography is also used during interventional catheterization to close a secundum atrial septal defect by guiding device placement.[15]
  • MRI is not indicated in the evaluation of a child with a suspected secundum atrial septal defect and does not add significantly to echocardiography findings.
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Other Tests

  • An ECG demonstrates sinus rhythm, often with evidence of right atrial enlargement manifested by tall, peaked P waves (usually best seen in leads II and V2) and prolongation of the PR interval. The QRS axis is slightly directed to the right (+100 º), and the precordial leads reveal right ventricular enlargement of the so-called volume overload type that is characterized by an rSR' pattern in leads V3 R and V1 with normal T waves.
  • The QRS duration may be mildly prolonged because of right ventricular dilation. This mimics the finding in right ventricular conduction delay.
  • A significant proportion (20-40%) of children with secundum atrial septal defect may not have abnormal ECG findings.[16]
  • Uncommonly, a patient with a secundum atrial septal defect may demonstrate a superior QRS axis with right ventricular enlargement, mimicking findings observed in the ECG of a patient with an ostium primum atrial septal defect (see Atrial Septal Defect, Ostium Primum).
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Procedures

  • Cardiac catheterization is not indicated in the routine evaluation of a child with a suspected secundum atrial septal defect. If concerns about pulmonary hypertension are noted, the pulmonary artery pressure and the reactivity of the pulmonary vascular resistance to vasodilators can be measured at cardiac catheterization.
  • Additional tests and procedures are necessary only in evaluation of other components of the patient's status, as indicated by complete history and physical examination.
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Contributor Information and Disclosures
Author

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul M Seib, MD  Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

  1. Gessner IH. Atrial septal defect. In: Surgery of Congenital Heart Disease: Pediatric Care Consortium 1984-1995. Armonk, NY: Futura Publishing Co.; 1998:31-44.

  2. Vick GW, Titus JL. Defects of the atrial septum, including the atrioventricular canal. In: Garson A, Bricker JT, Fisher, DJ, Neish, SR eds. The Science and Practice of Pediatric Cardiology. Vol 2. Baltimore, MD: Lippincott Williams & Wilkins; 1998.

  3. Azhari N, Shihata MS, Al-Fatani A. Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young. Apr 2004;14(2):148-55. [Medline].

  4. Saxena A, Divekar A, Soni NR. Natural history of secundum atrial septal defect revisited in the era of transcatheter closure. Indian Heart J. Jan-Feb 2005;57(1):35-8. [Medline].

  5. Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics. Oct 2006;118(4):1560-5. [Medline]. [Full Text].

  6. McMahon CJ, Feltes TF, Fraley JK, et al. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart. Mar 2002;87(3):256-9. [Medline].

  7. Scheuerle A. Clinical differentiation of patent foramen ovale and secundum atrial septal defect: a survey of pediatric cardiologists in Dallas, Texas, USA. J Registry Manag. Spring 2011;38(1):4-8. [Medline].

  8. Sachweh JS, Daebritz SH, Hermanns B, et al. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg. Jan 2006;81(1):207-13. [Medline].

  9. Caputo S, Capozzi G, Russo MG, et al. Familial recurrence of congenital heart disease in patients with ostium secundum atrial septal defect. Eur Heart J. Oct 2005;26(20):2179-84. [Medline].

  10. Sznajer Y, Keren B, Baumann C, et al. The spectrum of cardiac anomalies in Noonan syndrome as a result of mutations in the PTPN11 gene. Pediatrics. Jun 2007;119(6):e1325-31. [Medline]. [Full Text].

  11. Godwin KA, Sibbald B, Bedard T, Kuzeljevic B, Lowry RB, Arbour L. Changes in frequencies of select congenital anomalies since the onset of folic acid fortification in a Canadian birth defect registry. Can J Public Health. Jul-Aug 2008;99(4):271-5. [Medline].

  12. Wu ET, Akagi T, Taniguchi M, et al. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv. May 1 2007;69(6):866-71. [Medline].

  13. Walker RE, Moran AM, Gauvreau K, Colan SD. Evidence of adverse ventricular interdependence in patients with atrial septal defects. Am J Cardiol. Jun 1 2004;93(11):1374-7, A6. [Medline].

  14. Giardini A, Donti A, Formigari R, et al. Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults. J Am Coll Cardiol. May 19 2004;43(10):1886-91. [Medline].

  15. Rigatelli G, Dell' Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, et al. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. Congenit Heart Dis. Oct 20 2011;[Medline].

  16. Arrington CB, Tani LY, Minich LL, Bradley DJ. An assessment of the electrocardiogram as a screening test for large atrial septal defects in children. J Electrocardiol. Nov-Dec 2007;40(6):484-8. [Medline].

  17. Brassard M, Fouron JC, van Doesburg NH, Mercier LA, De Guise P. Outcome of children with atrial septal defect considered too small for surgical closure. Am J Cardiol. Jun 1 1999;83(11):1552-5. [Medline].

  18. Doll N, Walther T, Falk V, et al. Secundum ASD closure using a right lateral minithoracotomy: five-year experience in 122 patients. Ann Thorac Surg. May 2003;75(5):1527-30; discussion 1530-1. [Medline].

  19. Argenziano M, Oz MC, Kohmoto T, et al. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation. Sep 9 2003;108 Suppl 1:II191-4. [Medline]. [Full Text].

  20. Shah D, Azhar M, Oakley CM, et al. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J. Mar 1994;71(3):224-7; discussion 228. [Medline].

  21. Bolz D, Lacina T, Buser P, et al. Long-term outcome after surgical closure of atrial septal defect in childhood with extensive assessment including MRI measurement of the ventricles. Pediatr Cardiol. Sep-Oct 2005;26(5):614-21. [Medline].

  22. Lock JE, Cockerham JT, Keane JF, et al. Transcatheter umbrella closure of congenital heart defects. Circulation. Mar 1987;75(3):593-9. [Medline].

  23. Jones TK, Latson LA, Zahn E, et al. Results of the U.S. multicenter pivotal study of the HELEX septal occluder for percutaneous closure of secundum atrial septal defects. J Am Coll Cardiol. Jun 5 2007;49(22):2215-21. [Medline].

  24. Patel A, Lopez K, Banerjee A, Joseph A, Cao QL, Hijazi ZM. Transcatheter closure of atrial septal defects in adults > or =40 years of age: immediate and follow-up results. J Interv Cardiol. Feb 2007;20(1):82-8. [Medline].

  25. Post MC, Suttorp MJ, Jaarsma W, Plokker HW. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: a single-center experience. Catheter Cardiovasc Interv. Mar 2006;67(3):438-43. [Medline].

  26. Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. Nov 29 2007;357(22):2262-8. [Medline].

  27. Vida VL, Barnoya J, O'Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol. Jan 17 2006;47(2):326-31. [Medline].

  28. Butera G, Carminati M, Chessa M, et al. Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications. Am Heart J. Jan 2006;151(1):228-34. [Medline].

  29. Giardini A, Donti A, Specchia S, Formigari R, Oppido G, Picchio FM. Long-term impact of transcatheter atrial septal defect closure in adults on cardiac function and exercise capacity. Int J Cardiol. Feb 29 2008;124(2):179-82. [Medline].

  30. Brochu MC, Baril JF, Dore A, et al. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation. Oct 1 2002;106(14):1821-6. [Medline]. [Full Text].

 
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