Secundum Atrial Septal Defect Before and After Surgery
Twenty patients with secundum atrial septal defect, who had undergone open heart surgery were studied retrospectively. Girls were more affected than boys; the sex ratio was 1.5 : I. Associated cardiac defects were diagnosed in two patients, one with moderate valvular pulmonic stenosis and the other one with small ventricular septal defect. Typical clinical findings consisted of loud first heart sound, widely fixed split second heart sound and soft ejection systolic murmur at the upper left sternal border were heard in all cases. Mid diastolic murmur due to relative tricuspid stenosis was detected in most cases (75%).
Electrocardiographic findings included right axis deviation, prolonged PR-interval and right atrial enlargement were found in 50%, 15% and 60% of cases, respectively. Incomplete right bundle branch block and right ventricular enlargement were found in all cases, as was cardiomegaly with increased vascular markings were found in all cases. Paradoxical ventricular septal motion and visualization of the atrial septal defect were seen in 95% and 75% of cases, respectively. Cardiac catheterization was performed in 19 patients (95%). The pulmonary-systemic flow ratio (Qp/Qs) ranged from 1.7 to 6.3 (mean 2.9 Â± 0.67), and was correlated to the presence of mid diastolic tricuspid flow murmur and paradoxical ventricular septal motion.
Simple closure of the defect was the procedure of choice, but in one patient (5%) pericardial patch was used to close the very large defect. The mortality rate was 10 percent.
Physical retardation was found in all boys and 50% of girls, before surgery. Body weight percentile increased in most cases (61.1 %), while body height percentile increased in only 5.6% of cases, postoperatively. Ejection systolic murmur at the upper left sternal border was still detected in one patient (5.6%). lncomplele right bundle branch block persisted in all cases, while cardiomegaly was still found in 5. 6% of cases followed up six months to five years after surgery. There was no residual left ventricular dysfunction in all cases.
AMPLATZ, K.; FORMANEL, A.; KNIGHT, L.; TADAVARTHY, S.M.; GYPSER, G.; BARDADI, G.: Radiographic changes in the postoperative patients. Prog. Cardiovasc. Dis. 7: 406-438 (1975). https://doi.org/10.1016/S0033-0620(75)80002-8
Anderson, A.W.; Rogers, M.C.; Canet, R.V. Jr.; SPACH, M.S.: Atrioventricular conducti Â® in secundum atrial septal defect. Circulation 48: 23 (1973). https://doi.org/10.1161/01.CIR.48.1.27
Anthony, C.L.; Arnon, R.G.; Fitch, C.W.: Atrial septal defect; in Pediatric Cardiology; 1st ed., pp 196-205 (Topan, Singapore 1979).
BEHRMAN, R.E.; VAUGHAN, V.C.; Atrial septal defect; in Nelson Textbook of Pediatrics; 13th ed., pp 984-987 (Saunders, Philadelphia).
Chan, K.Y.; Tay, J.S.H.; Yip, W.C.L.; Wong, H.B.: Growth retardation in children with congenital heart disease. The Journal of the Singapore Paediatric Society. 29: 185-193 (1987). PMid:3657091
Feldt, R.H.; Strickler, G.B.; Weidman, W.H.: Growthn of children with congenital heart disease. Am.J. Dis. Child. 117: 573-579. (1969). https://doi.org/10.1001/archpedi.1969.02100030283005 PMid:4181126
Feldt, R.H.; Edwards, W.D.; Puga, F.J.; Seward, J. B.; Weidman, W.H. : Atrial septal defect and atrioventricular canal; in Adams, F.H.; Emmanouilides, G.C., Moss' Heart Disease in Infants, Children and Adolescents; 3rd ed ., pp 118-134 (Williams and Wilkins, Baltimore 1983).
Graham, T.P. Jr.: Ventricular performance in adult after operation for congenital heart disease; in Engle, M.A.; Perloff, J ., Congenital Heart Disease After Surgery. Benefit, Residual, Sequelae; 1st ed., pp 332-343 (Yorke Medical Books, New York 1983). PMid:6852896
Graham, T.D.: When to operate on a child with congenital heart disease. Pediat. Clins N. Am. 31: 1275-1291 (1984). https://doi.org/10.1016/S0031-3955(16)34721-6
MADIYONO, B.; TRISNOHADI, H.B.; AFFANDI, M.B.: His bundle electrocardiogram in children with secundum atrial septal defect. Paediatr. lndones. 21: 1-10 (1981).
MADIYONO, B.; OESMAN, I.N.; SASTROASMORO, S.; PUTRA, S.T.; SOELAEMAN, E.J.; RACHMAD, K.B.: Patent ductus arteriosus before and after surgery. Paediatr. lndones. 29: 39-51 (1989).
McNamara, D.G.; Latson, L.A.: Longterm follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more; in Engle, M.A.; Perloff, J., Congenital Heart Disease After Surgery; Benefit, Residual, and Sequelae; 1st ed ., pp 77-99 (Yorke Medical Books, New York 1983).
Mehrizi, A.; Drash, A.: Growth disturbance in congenital heart disease. J. Pediat. 61: 418-429 (1962). https://doi.org/10.1016/S0022-3476(62)80373-4
Meredith, J .; Titus, J.L. : The anatomic atrial connection between sinus and AV-node. Circulation 37: 366 (1968).
Nadas, A.S.; Fyler, D.C.: Interatrial communications; in Pediatric Cardiology; 2nd ed., pp 317-348 (Saunders, Philadelphia 1972).
Pearlman, A.S.; Borer, J.S.; Clark, C.E.: Abnormal ventricular size and ventricular septal motion after atrial septal defect closure. Am. J . Cardiol. 41 : 295-301 (1978). https://doi.org/10.1016/0002-9149(78)90168-6
Perloff, J.K.: Atrial septal defect, in The Clinical Recognition of Congenital Heart Disease; 3rd ed., pp 272-349 (Saunders, Philadelphia 1987).
RACHMAD, K.B.: Tindakan pembedahan jantung pada penyakit jantung bawaan . Diagnosis dan Penatalaksanaan Penyakit Jantung Bawaan yang dapat Dikoreksi. Naskah Lengkap Pendidikan Tambahan Berkala Ilmu Kesehatan Anak XI, Fakultas Kedokteran Universitas Indonesia, pp 88-96, Jakarta 31 Juni-1 Agustus 1985.
Sastroasmoro, S.; Madiyono, B.; Oesman, I.N.; Affandi, M.B.: Penatalaksanaan pasca bedah penyakit jantung bawaan. Diagnosis dan Penatalaksanaan Penyakit Jantung Bawaan yang dapat Dikoreksi. Naskah Lengkap Pendidikan Tambahan Berkala Ilmu Kesehatan Anak XI, Fakultas Kedokteran Universitas Indonesia, pp 97-107, Jakarta 31 Juli Agustus 1985.
Suoninen, P.: Physical growth of children with congenital heart disease. Pre- and postoperative study of 355 cases. Acta Paediat. scand. Suppl. 225, pp 16-21 (1971).
YOUNG, D.: Later result of secundum atrial septal defect in children. Am. J. Cardiol. 30: 884-887 (1973). https://doi.org/10.1016/0002-9149(73)90804-7
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.