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Natural History of Secundum ASD in Preterm and Term Neonates: A Comparative Study

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Abstract

Atrial septal defects (ASDs) are common in neonates. Although past studies suggest ASDs  ≥ 3 mm in term neonates (TNs) are less likely to close, there is paucity of data regarding the natural history in preterm neonates (PNs), information that would inform surveillance. We sought to compare spontaneous closure rates and need for intervention for ASDs in TNs/near term (≥ 36 weeks) versus PNs (< 36 weeks). We included all TNs and PNs who underwent echocardiography at ≤ 1 month between 2010 and 2018 in our institution with an ASD ≥ 3 mm, without major congenital heart disease, and with repeat echocardiogram(s). Spontaneous resolution was defined as size diminution to < 3 mm or closure. We included 156 TNs (mean gestational age at birth 38.6 ± 1.4 weeks) and 156 PNs (29.6 ± 3.7 weeks) with a mean age at follow-up of 16 ± 19 and 15 ± 21 months, respectively (p = 0.76). Based on maximum color Doppler diameter, in TNs, ASD resolution occurred in 95% of small (3–5 mm), 87% of moderate (5.1–8 mm), and 60% of large (> 8 mm) defects; whereas, in PNs, resolution occurred in 79% of small, 76% of moderate, and 33% of large ASDs. There was a significant association between size and ASD resolution in TNs (p = 0.003), but not PNs (p = 0.17). Overall, ASD resolution rate was higher in TNs (89%) versus PNs (78%) (p = 0.009), and fewer TNs (1%) compared to PNs (7%) required ASD intervention (p = 0.02). Most ASDs identified in TNs and PNs spontaneously resolve. PNs, however, demonstrate lower ASD resolution and higher intervention rates within all size groups. These data should inform follow-up of affected neonates.

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Abbreviations

ASD:

Atrial Septal Defect

TN:

Term neonate, term-born neonate

PN:

Preterm neonate, preterm-born neonate

CHD:

Congenital heart disease

2D:

Two dimensional

PDA:

Patent ductus arteriosus

VSD:

Ventricular septal defect

GA:

Gestational age

AoV:

Aortic valve

ASD:AoV:

Ratio: atrial septal defect to aortic valve

BPD/CLD:

Bronchopulmonary dysplasia/chronuc lung disease

CT:

Computed tomography

FTT:

Failure to thrive

RTI:

Respiratory tract infection

RV:

Right ventricle

PH:

Pulmonary hypertension

L to R:

Left to right

R to L:

Right to left

References

  1. van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, Roos-Hesselink JW (2011) Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol 58(21):2241–2247. https://doi.org/10.1016/j.jacc.2011.08.025

    Article  PubMed  Google Scholar 

  2. Radzik D, Davignon A, van Doesburg N, Fournier A, Marchand T, Ducharme G (1993) Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life. J Am Coll Cardiol 22(3):851–853. https://doi.org/10.1016/0735-1097(93)90202-c

    Article  CAS  PubMed  Google Scholar 

  3. Geva T, Martins JD, Wald RM (2014) Atrial septal defects. The Lancet 383(9932):1921–1932. https://doi.org/10.1016/s0140-6736(13)62145-5

    Article  Google Scholar 

  4. Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C (2006) Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics 118(4):1560–1565. https://doi.org/10.1542/peds.2005-3037

    Article  PubMed  Google Scholar 

  5. McMahon CJ, Feltes TF, Fraley JK, Grifka RG, Tortoriello TA, Blake R, Bezold LI (2002) Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 87(3):256–259. https://doi.org/10.1136/heart.87.3.256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Riggs T, Sharp SE, Batton D, Hussey ME, Weinhouse E (2000) Spontaneous closure of atrial septal defects in premature vs full-term neonates. Pediatr Cardiol 21(2):129–134. https://doi.org/10.1007/s002469910020

    Article  CAS  PubMed  Google Scholar 

  7. Demir T, Öztunç F, Eroğlu AG, Saltık L, Ahunbay G, Kutluğ Ş, Güzeltaş A, Altun G (2008) Outcome for patients with isolated atrial septal defects in the oval fossa diagnosed in infancy. Cardiol Young 18(01):75–78. https://doi.org/10.1017/s1047951107001692

    Article  PubMed  Google Scholar 

  8. Azhari N, Shihata MS, Al-Fatani A (2004) Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young 14(2):148–155. https://doi.org/10.1017/s1047951104002069

    Article  PubMed  Google Scholar 

  9. Brassard M, Fouron J-C, van Doesburg NH, Mercier L-A, De Guise P (1999) Outcome of children with atrial septal defect considered too small for surgical closure. Am J Cardiol 83(11):1552–1555. https://doi.org/10.1016/s0002-9149(99)00146-0

    Article  CAS  PubMed  Google Scholar 

  10. Fukazawa M, Fukushige J, Ueda K (1988) Atrial septal defects in neonates with reference to spontaneous closure. Am Heart J 116(1):123–127. https://doi.org/10.1016/0002-8703(88)90259-1

    Article  CAS  PubMed  Google Scholar 

  11. Tin W, Lal M (2015) Principles of pulse oximetry and its clinical application in Neonatal Medicine. Semin Fetal Neonatal Med 20(3):192–197. https://doi.org/10.1016/j.siny.2015.01.006

    Article  PubMed  Google Scholar 

  12. El-Khuffash A, Herbozo C, Jain A, Lapointe A, McNamara PJ (2013) Targeted neonatal echocardiography (tnecho) service in a Canadian neonatal intensive care unit: a 4-Year experience. J Perinatol 33(9):687–690. https://doi.org/10.1038/jp.2013.42

    Article  CAS  PubMed  Google Scholar 

  13. Ozcelik N, Atalay S, Tutar E, Ekici F, Atasay B (2006) The prevalence of interatrial septal openings in newborns and predictive factors for spontaneous closure. Int J Cardiol 108(2):207–211. https://doi.org/10.1016/j.ijcard.2005.05.023

    Article  PubMed  Google Scholar 

  14. de Waal K, Costley N, Phad N, Crendal E (2019) Left ventricular diastolic dysfunction and diastolic heart failure in preterm infants. Pediatr Cardiol 40(8):1709–1715. https://doi.org/10.1007/s00246-019-02208-x

    Article  PubMed  Google Scholar 

  15. Bensley JG, Stacy VK, De Matteo R, Harding R, Black MJ (2010) Cardiac remodelling as a result of pre-term birth: implications for future cardiovascular disease. Eur Heart J 31(16):2058–2066. https://doi.org/10.1093/eurheartj/ehq104. (Epub 2010 May 7 PMID: 20453064)

    Article  CAS  PubMed  Google Scholar 

  16. Bostan OM, Cil E, Ercan I (2007) The prospective follow-up of the natural course of interatrial communications diagnosed in 847 newborns. Eur Heart J 28(16):2001–2005. https://doi.org/10.1093/eurheartj/ehm268

    Article  PubMed  Google Scholar 

  17. Kim, Young Jin MD, PhD*; Hur, Jin MD*; Choe, Kyu Ok MD, PhD*; Choi, Byoung Wook MD, PhD*; Shim, Chi-Young MD†; Choi, Eui-Young MD†; Kwon, Hae Sik MD‡. Interatrial Shunt Detected in Coronary Computed Tomography Angiography: Differential Features of a Patent Foramen Ovale and an Atrial Septal Defect. Journal of Computer Assisted Tomography 32(5):p 663–667, September 2008. | DOI: https://doi.org/10.1097/RCT.0b013e31815b6421

  18. Graziano JN (2005) Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the congenital diaphragmatic hernia study group. J Pediatr Surg 40(6):1045–1050. https://doi.org/10.1016/j.jpedsurg.2005.03.025

    Article  PubMed  Google Scholar 

  19. Vogel JP, Chawanpaiboon S, Moller A-B, Watananirun K, Bonet M, Lumbinon P (2018) The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol 52:3–12. https://doi.org/10.1016/j.bpobgyn.2018.04.003

    Article  PubMed  Google Scholar 

  20. Petrou S, Abangma G, Johnson S, Wolke D, Marlow N (2009) Costs and health utilities associated with extremely preterm birth: evidence from the epicure study. Value Health 12(8):1124–1134. https://doi.org/10.1111/j.1524-4733.2009.00580.x

    Article  PubMed  Google Scholar 

  21. Nuffield Council on Bioethics (2006) Critical care decisions in fetal and neonatal medicine: ethical issues. Nuffield Council on Bioethics, London

    Google Scholar 

  22. Yoon SA, Hong WH, Cho HJ (2020) Congenital heart disease diagnosed with echocardiogram in newborns with asymptomatic cardiac murmurs: a systematic review. BMC Pediatr. https://doi.org/10.1186/s12887-020-02212-8

    Article  PubMed  PubMed Central  Google Scholar 

  23. Migda M, Gieryn K, Migda B (2018) Utility of doppler parameters at 36–42 weeks’ gestation in the prediction of adverse perinatal outcomes in appropriate-for-gestational-age fetuses. J Ultrason 18(72):22–28. https://doi.org/10.15557/jou.2018.0004

    Article  PubMed  PubMed Central  Google Scholar 

  24. Aguilera J, Semmler J, Coronel C, Georgiopoulos G, Simpson J, Nicolaides KH, Charakida M (2020) Paired maternal and fetal cardiac functional measurements in women with gestational diabetes mellitus at 35–36 weeks’ gestation. Am J Obstetr Gynecol. https://doi.org/10.1016/j.ajog.2020.04.019

    Article  Google Scholar 

  25. Sanfilippo, A., Bewick, D., Chan, K., Cujec, B., Dumesnil, J. G., Honos, G., Munt, B., Sasson, Z., Tam, J., & Tomlinson, C. (2004, October 23). Guidelines for the provision of echocardiography in Canada. Canadian Cardiovascular Society. https://ccs.ca/wp-content/uploads/2020/12/Echo_STDP_2004.pdf

  26. Cantinotti M, Scalese M, Murzi B, Assanta N, Spadoni I, Festa P, De Lucia V, Crocetti M, Marotta M, Molinaro S, Lopez L, Iervasi G (2014) Echocardiographic nomograms for ventricular, valvular and arterial dimensions in Caucasian children with a special focus on neonates, infants and toddlers. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2013.10.001

    Article  PubMed  Google Scholar 

  27. van Ark AE, Molenschot MC, Wesseling MH, de Vries WB, Strengers JLM, Adams A, Breur JMPJ (2018) Cardiac valve annulus diameters in extremely preterm infants: a cross-sectional echocardiographic study. Neonatology 114(3):198–204. https://doi.org/10.1159/000488387

    Article  PubMed  Google Scholar 

  28. Pollick C, Sullivan H, Cujec B, Wilansky S (1988) Doppler color-flow imaging assessment of shunt size in atrial septal defect. Circulation 78(3):522–528. https://doi.org/10.1161/01.cir.78.3.522

    Article  CAS  PubMed  Google Scholar 

  29. Faletra F, Scarpini S, Moreo A, Ciliberto GR, Austoni P, Donatelli F, Gordini V (1991) Color doppler echocardiographic assessment of atrial septal defect size: correlation with surgical measurements. J Am Soc Echocardiogr 4(5):429–434. https://doi.org/10.1016/s0894-7317(14)80375-1

    Article  CAS  PubMed  Google Scholar 

  30. Tanghöj G, Liuba P, Sjöberg G, Naumburg E (2020) Predictors of the need for an atrial septal defect closure at very young age. Front Cardiovasc Med 10(6):185. https://doi.org/10.3389/fcvm.2019.00185.PMID:31998753;PMCID:PMC6965016

    Article  Google Scholar 

  31. Lammers A, Hager A, Eicken A, Lange R, Hauser M, Hess J (2005) Need for closure of secundum atrial septal defect in infancy. J Thorac Cardiovasc Surg 129(6):1353–1357. https://doi.org/10.1016/j.jtcvs.2004.10.007. (PMID: 15942577)

    Article  PubMed  Google Scholar 

  32. Charisopoulou D, Bini RM, Riley G, Janagarajan K, Moledina S, Marek J (2020) Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension. Cardiol Young 30(4):511–520. https://doi.org/10.1017/S1047951120000463. (Epub 2020 Mar 16 PMID: 32172702)

    Article  PubMed  Google Scholar 

  33. Thomas VC, Vincent R, Raviele A, Diehl H, Qian H, Kim D (2012) Transcatheter closure of secundum atrial septal defect in infants less than 12 months of age improves symptoms of chronic lung disease. Congenit Heart Dis 7(3):204–11. https://doi.org/10.1111/j.1747-0803.2010.00442.x. (Epub 2011 Mar 28 PMID: 21443579)

    Article  PubMed  Google Scholar 

  34. Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, Sánchez PJ, Shankaran S, Van Meurs KP, Ball MB, Hale EC, Newman NS, Das A, Higgins RD, Stoll BJ (2015) Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 372(4):331–340. https://doi.org/10.1056/nejmoa14034

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

Partial financial support was received from Faculty of Medicine and Dentistry at University of Alberta and Alberta Innovates.

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Authors and Affiliations

  1. Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, University of Alberta, Women & Children’s Health Research Institute, and the Stollery Children’s Hospital, WCMC, 8440 112th Street Edmonton, Alberta, T6G 2B7, Canada

    Negar Heidari, Joseph J. Pagano & Lisa K. Hornberger

  2. Division of Neonatology, Department of Pediatrics, University of Alberta, Women & Children’s Health Research Institute, and the Stollery Children’s Hospital, Alberta, Canada

    Kumar Kumaran

  3. Department of Obstetrics & Gynecology, Lois Hole Hospital for Women, Royal Alexandra Hospital, University of Alberta, 10245 111th Street Edmonton, Alberta, T5G 0B6, Canada

    Lisa K. Hornberger

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  1. Negar Heidari
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Contributions

NH designed the study, collected data, carried out statistical analyses, drafted the initial manuscript, and revised the manuscript. Dr. KK conceptualized the study, arranged data sharing from institution, reviewed and revised the manuscript. Dr. JJP conceptualized the study, reviewed and revised the manuscript. Dr. LKH conceptualized and designed the study, coordinated and supervised data collection and statistical analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Lisa K. Hornberger.

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The authors have no relevant financial or non-financial interests to disclose.

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Ethics Approval for this retrospective study was granted by the University of Alberta Ethics Board.

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Heidari, N., Kumaran, K., Pagano, J.J. et al. Natural History of Secundum ASD in Preterm and Term Neonates: A Comparative Study. Pediatr Cardiol 45, 710–721 (2024). https://doi.org/10.1007/s00246-023-03403-7

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