Presentation of Atrial Septal Defect in the Pediatric Population

Our recent experience indicates that patients with a hemodynamically significant atrial septal defect secundum (ASD²) do not necessarily present with classic physical and electrocardiographic (ECG) findings. The purpose of the study was to review the records of patients either receiving a catheter device or undergoing surgical repair for the closure of ASD² to determine their initial physical and ECG findings. Therefore, we did a retrospective review of 47 consecutive patients who had echocardiographic evidence of a hemodynamically significant isolated ASD² and who underwent ASD² closure. Of these 47 patients, the presenting complaints were murmur (n = 36), chest pain (n = 6), seizure (n = 1), stroke (n = 1), syncope (n = 1), Kawasaki’s disease (n = 1), and cardiomegaly (n = 1). Charts were reviewed for the evaluation of four abnormal physical findings: hyperactive right ventricular impulse, split fixed second heart sound, systolic and diastolic flow murmurs; and three ECG abnormalities: right axis deviation, right atrial enlargement, and evidence of right ventricular hypertrophy. In all, 30% of patients had either one or no typical physical findings, 18% had normal ECG findings, and 7% had no physical or ECG findings. On physical examination and ECG, the abnormalities due to ASD² may be too subtle to detect. Although it is well known that variations can occur in the clinical signs and symptoms typical of ASD², dependence on classical physical and or ECG findings may result in the underdiagnosis of a significant number of patients.