Outcome of children with atrial septal defect considered too small for surgical closure

There are few studies providing information on the natural course of hemody namically insignificant atrial septal defect (ASD). To review the outcome o f patients with secundum ASD, we retrospectively reviewed the charts of pat ients who had initially not been considered for surgical closure after age 1 year, and who had either a follow-up of at least 10 years or documented c losure. Thirty patients, 22 females and 8 males, fulfilled our inclusion cr iteria. Mean age at diagnosis was 1.3 year and mean follow-up duration was 11.5 years. Seventeen patients had spontaneous closure of the ASD at a mean age of 8.4 years, There were 7 asymptomatic patients whose ASD was still p atent at the last visit (mean age 14.1 years, mean follow-up 13.2), with de fect dimensions on echocardiography ranging from 1 to 6 mm, The remaining 6 patients were considered to require surgical closure on the basis of an ap parent increase in size of the ASD and secondary clinical and hemodynamic m anifestations, These results (1) confirm that not all secundum ASDs need to be treated surgically because they can still spontaneously close past the age of 5, and (2) suggest that in a minority of cases the size of the defec t could increase. (C) 1999 by Excerpta Medica, Inc.