Pediatric Cardiology

, Volume 37, Issue 4, pp 686–695 | Cite as

Echocardiographic Reference Values for Right Atrial Size in Children with and without Atrial Septal Defects or Pulmonary Hypertension

  • Martin Koestenberger
  • Ante Burmas
  • William Ravekes
  • Alexander Avian
  • Andreas Gamillscheg
  • Gernot Grangl
  • Marlene Grillitsch
  • Georg Hansmann
Original Article


Right atrial (RA) size may become a very useful, easily obtainable, echocardiographic variable in patients with congenital heart disease (CHD) with right-heart dysfunction; however, according studies in children are lacking. We investigated growth-related changes of RA dimensions in healthy children. Moreover, we determined the predictive value of RA variables in both children with secundum atrial septal defect (ASD) and children with pulmonary hypertension (PH) secondary to CHD (PH-CHD). This is a prospective study in 516 healthy children, in 80 children with a secundum ASD (>7 mm superior–inferior dimension), and in 42 children with PH-CHD. We determined three RA variables, i.e., end-systolic major-axis length, end-systolic minor-axis length, and end-systolic area, stratified by age, body weight, length, and surface area. RA end-systolic length and area z scores were increased in children with ASD and PH-CHD when compared to those variables in the healthy control population. Using the Youden Index to determine the best cutoff scores in sex- and age-specific RA dimensions, we observed a sensitivity and specificity up to 94 and 91 %, respectively, in ASD children and 98 and 94 %, respectively, in PH-CHD children. We provide normal values (z scores −2 to +2) for RA size and area in a representative, large pediatric cohort. Enlarged RA variables with scores >+2 were predictive of secundum ASD and PH-CHD. Two-dimensional determination of RA size can identify enlarged RAs in the setting of high volume load (ASD) or pressure load (PH-CHD).


Atrial septal defect Children End-systolic length and area Pulmonary hypertension secondary to congenital heart disease Right atrial enlargement 


Compliance with ethical standards

Conflict of interest

All authors state that there are no financial, personal, or other relationships with other people or organizations that could inappropriately influence our work to disclose.

Supplementary material

246_2015_1332_MOESM1_ESM.docx (25 kb)
Supplemental Table A.) Body weight (BW) related and B.) body length (BL) related z scores for RA area, major-axis and minor-axis length are shown. The values in the table are shown as follows: For each BW group, the estimated mean and ± 2 z scores according to the regression analysis of the RA mean, length, and minor axis are shown. The range ± 2 z scores represent the expectable normal intervals of deviation for a certainty level of 95 % (DOCX 24 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Martin Koestenberger
    • 1
  • Ante Burmas
    • 1
  • William Ravekes
    • 2
  • Alexander Avian
    • 3
  • Andreas Gamillscheg
    • 1
  • Gernot Grangl
    • 1
  • Marlene Grillitsch
    • 1
  • Georg Hansmann
    • 4
  1. 1.Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
  2. 2.Division of Pediatric CardiologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Institute for Medical Informatics, Statistics and DocumentationMedical University GrazGrazAustria
  4. 4.Department of Pediatric Cardiology and Critical CareHannover Medical SchoolHannoverGermany

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