Assessment of the clinical features of children with isolated atrial septal defect

Introduction and Aim: Atrial septal defect (ASD) is a disease which goes undetected more commonly than other congenital heart diseases, due to its insidious clinical findings. Patients with ASD can live a healthy and normal life with early diagnosis and proper treatment. Therefore, it was aimed in this study to point out valuable information for clinicians contributing timely diagnosis of this anomaly by explicating symptoms, physical examination and laboratory findings of the patients with isolated ASD. Materials and Methods: We reviewed symptoms as well as telecardiography, electrocardiography and echocardiography findings of patients diagnosed with isolated ASD in our outpatient clinic. Patients were grouped and compared according to their age, gender, the presence of cardiomegaly and dilatation of the right-sided heart chambers. Results: Fifty patients were included in the study, of which 28 (56%) were female and 22 (44%) were male. Forty-six (92%) had secundum ASD, two (4%) had primum ASD and two (4%) had sinus venosus ASD. Nineteen (38%) patients were symptom free. The most common complaint was easy fatigability (32%), whereas palpitation and syncope were the least common complaints (6%). Eighty eight percent of the patients had systolic murmurs of various intensities and 24% had fixed splitting of S2. In six patients (12%), the physical examination was unremarkable and three (6%) of them were symptom free. Cardiomegaly was detected in 21 patients (42%). According to the electrocardiography findings, 22% of the patients had incomplete right bundle branch block pattern and 18% had the findings of right ventricular hypertrophy. The patients with enlargement of right heart chambers had significantly higher prevalence of incomplete right bundle branch block pattern and right ventricular hypertrophy findings on electrocardiography, cardiomegaly, and mitral valve prolapsus when compared to the ones with no enlargement. Discussion and Conclusion: The symptoms like easy fatigability, recurrent pulmonary infections, coughing, failure to thrive, shortness of breath, and chest pain may be warning signs of ASD. However, it should be kept in mind that some patients with ASD can be asymptomatic. Therefore, a thorough examination of the cardiovascular system in all patients presenting with any reason may prevent delayed diagnosis of ASD. Detection of a systolic murmur at the left upper sternal border, fixed splitting of S2, and telecardiographic evidence of cardiomegaly are important findings for the diagnosis of ASD.