Atrial septal defect in infants and children
| Autor: | Paul Adams, Ray C. Anderson, Joseph Jorgens, Bertram Levin, Rosalind Novick, Robert B. Disenhouse |
|---|---|
| Rok vydání: | 1954 |
| Předmět: |
medicine.medical_specialty
Heart disease medicine.diagnostic_test business.industry medicine.medical_treatment Cardiovascular Abnormalities Infant medicine.disease Cardiovascular System Pulmonary hypertension Heart Septal Defects Atrial Surgery Right ventricular hypertrophy Internal medicine medicine.artery Pediatrics Perinatology and Child Health Pulmonary artery Left atrial enlargement medicine Cardiology Humans Right axis deviation business Electrocardiography Cardiac catheterization |
| Zdroj: | The Journal of Pediatrics. 44:269-289 |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/s0022-3476(54)80316-7 |
| Popis: | Summary Twenty-one patients were studied in whom the diagnosis of atrial septal defect was established by cardiac catheterization. In addition, a survey was made of 202 post-mortem examinations on children with congenital heart disease, and a review made of the six cases, all infants, in whom the atrial defect appeared to be the primary cause of death. The principal symptoms in the infants were feeding difficulties, recurrent respiratory infections, and growth retardation, and in the older children, respiratory infections, exertional dyspnea, and decreased exercise tolerance. Although children with atrial septal defect usually lead active and normal lives, the defect may lead to serious difficulty and death in infancy. Cardiac failure may occur early in life. No cardiac signs are pathognomonic. The typical case showed increased precordial activity, displacement of the apex beat to the left, a moderately loud systolic murmur in the first, second, and third left interspaces, and an accentuated second pulmonic sound. Thrills were not frequently found. Clinical findings were more variable in the infants and accurate clinical diagnosis was extremely difficult. The poor physical development of these children was not noted as frequently as has been emphasized in the past. No typical electrocardiographic picture occurred, but right axis deviation and right ventricular hypertrophy were frequently observed. Unipolar lead electrocardiography was found to be of great value. Roentgenographic and roentgenoscopic examinations were of considerable diagnostic aid and typically showed enlargement of the right atrium and right ventricle, dilation of the pulmonary artery, and a small aortic knob. Pulmonary artery dilation was especially prominent in the infants. Left atrial enlargement was absent in all cases. Excepting the infant group, there was in general no relation between the heart size and general condition of the patient. Cardiac catheterization is the best method to date of substantiating the diagnosis during life. Some of the limitations and pitfalls of this procedure are discussed. Evidence of left-to-right shunt was found in every case, and the catheter was passed through the defect in approximately 50 per cent. Pulmonary hypertension was found infrequently but was a fairly consistent finding in the catheterized infants. In no case was the hypertension of a severe nature. Three cases have undergone successful surgical closure of the atrial defect at the University of Minnesota Hospitals. The indications for surgery are discussed briefly as in the clinical management of children with this type of cardiac defect. Stress is placed on early diagnosis of this anomaly since the development of surgical treatment may make possible the salvage of infants who would otherwise die. |
| Databáze: | OpenAIRE |
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