생후 3개월 이내의 영아에서 진단된 단독 이차공 심방중격결손의 자연 경과

Abstract

PURPOSE: Secundum atrial septal defect comprises about 5-10% of all congenital heart disease and spontaneous closure rate is known to be about 40% in children younger than 4 years at the time of diagnosis. However, the natural course of secundum atrial septal defect in young infants before 3 months of age at the time of diagnosis was rarely reported. So we studied the natural course of secundum atrial septal defect in infant.

METHODS: We investigated 81 cases of secundum atrial septal defect at the Division of Pediatric Cardiology, Yonsei University Cardiovascular Center from Feb. 1992 to Aug. 1997. The control group(30 cases) had no cardiac murmur and no evidence of congenital heart disease, and were screened for interatrial shunt and ventricular septal motion with echocardiograms, within 5 days after birth. According to the defect size, the case groups were divided into 4 groups by echocardiography:Group 1:Diameter(d)< or =3 mm(25 cases), Group 2:3 mm8 mm(11 cases) and were followed up for an average of 16+/-10.7 months. The spontaneous closure and ventricular septal motion of the case group was compared to the control group.

RESULTS: Spontaneous closure was noted in 56 cases(69.1%), and operation was performed in 3 cases(3.7%) of non-closure patients. The interatrial shunt was noted in 5 cases(16.7%) of the control group by color flow mapping. The shunt sizes measured by color flow mapping were 1.9 mm, 2.0 mm, 2.1 mm, 2.3 mm and 2.5 mm. In the case group, spontaneous closure was noted in 25 cases(100%) of Group 1, 21 cases(95.4%) of Group 2, 10 cases(43.5%) of Group 3 and 1 case(9.1%) of Group 4. In the control group, 5 cases(16.7%) of atrial septal defect were detected by color flow mapping but not detected by 2 dimensional(2D) echocardiogram. In the subject group, 63 cases(77.8%) of atrial septal defect were diagnosed by 2D echocardiogram, but all cases of atrial septal defect were diagnosed by Doppler echocardiogram. Paradoxical septal motion was noted 13 cases(16.1%) of the subject group, but normal ventricular septal motion was noted in all cases of the control group. Spontaneous closure was noted in all cases of group 1 within 14 months of the follow-up period. In group 2, the spontaneous closure rate was 95% within 24 months. In group 3, the spontaneous closure rate was 70% within 27 months and no spontaneous closure was noted after the period. In group 4, the spontaneous closure rate was 9.1%(1 case) within 43 months and no spontaneous closure was noted after this period.

CONCLUSION: The size of the atrial septal defect had an inverse correlation with the spontaneous closure rate, and the size below 3 mm measured by color flow mapping did not require treatment. There was positive correlation between the size of the atrial septal defect and paradoxical septal motion. An atrial septal defect with a d >8 mm may have little chance of closing spontaneously and the possibility of surgical correction shoud be considered.