European Heart Journal Advance Access originally published online on July 10, 2007
European Heart Journal 2007 28(16):2001-2005; doi:10.1093/eurheartj/ehm268
The prospective follow-up of the natural course of interatrial communications diagnosed in 847 newborns
Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Uludag University, Görükle, 16059 Bursa, Turkey
Received 3 November 2006; revised 20 April 2007; accepted 31 May 2007; online publish-ahead-of-print 10 July 2007.
* Corresponding author. Tel: +90 224 4428143; fax: +90 224 4428143. E-mail address: ombostan{at}uludag.edu.tr
Aims: The aim of this study was to evaluate the prevalance of interatrial communications (IACs) and IAC types in a large series of newborns, to establish the incidence of spontaneous closure of IACs, to determine the relationship between spontaneous closure and the size and type of IACs, and to investigate the incidence of mitral valve prolapse (MVP) and atrial arrhythmia in newborn infants with atrial septal aneurysm (ASA).
Methods and results: Between 2000 and 2001, a total of 1100 asymptomatic and term newborns were evaluated. Those who had congenital heart diseases and failed to attend the follow-up visits were excluded from the study. The remaining 847 newborns were followed until the closure time or in those where closure did not occur, for a maximum time of 45 months (mean 25 ± 3 months, range 1–45 months). The mean age at diagnosis was 1.7 ± 1.4 days (range 1–7 days). According to echocardiographic evaluation, cases were classified into four groups based on the initial size of IAC and into three groups based on the type of IAC. At the end of the 45th month IACs were closed spontaneously in 98.6% of the cases. There was significant relationship between the diameter of IAC and the timing of the closure (P < 0.01). The closure time in the cases with ASA was significantly longer than the cases with valve-like opening and multiple fenestration (P < 0.01). In female newborns, the defects remained open for a significantly longer period than male newborns (P = 0.0397). There was no significant relationship between ASA and atrial arrhythmias (P = 0.294). None of the newborns had MVP.
Conclusion: The cases with IACs < 3 mm do not need follow-up. However, the cases with IACs > 3 mm do need to be followed until the defect closes completely. Those with ASA should be followed-up regularly, because these defects can remain open. Spontaneous closure occurs significantly earlier in cases with valve-like opening and multiple fenestration.
Key Words: Interatrial communications • Atrial septal aneurysm • Newborn