Pediatrics & Neonatology
Volume 49, Issue 6 , Pages 234-239, December 2008

A Follow-up Study of Neonatal Interatrial Shunt with Echocardiography until Twelve to Fifteen Months of Age

  • Chi-Lin Ho

      Affiliations

    • Department of Pediatrics, Cheng-Ching Hospital, Taichung, Taiwan
    • Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Sheng-Ling Jan

      Affiliations

    • Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Taichung Veterans General Hospital, 160 Section 3, Chung-Kang Road, Taichung 40705, Taiwan
    • ,
  • Ming-Chih Lin

      Affiliations

    • Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
    • ,
  • Yun-Ching Fu

      Affiliations

    • Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

Received 20 May 2008; received in revised form 7 July 2008; accepted 19 September 2008.

Article Outline

Objective

To assess the incidence and natural history of full-term neonates with interatrial shunt (IAS).

Methods

A follow-up study of 1389 neonates who received screening echocardiography between 2003 and 2006. Babies with IAS at 2 to 4 days of life underwent follow-up echocardiography at 2 to 4 months, 6 to 9 months and 12 to 15 months of age until closure of IAS.

Results

The ratio of IAS was 68.3% initially. No significant demographic differences were identified between infants with and without initial IAS. Among 949 neonates with initial IAS, 84.5% infants had a left-to-right interatrial shunt, 13.5% had bidirectional shunt and 2% had predominantly right-to-left shunt. The persistence rate of IAS at 12 to 15 months of age was 3.8% (44/1166). The initial size of IAS ranged from 1.2 to 7.7 mm (4.3 ± 1.1 mm) detected by color Doppler flow mapping and cases were divided into three groups: small (≦5 mm), medium (5 to 8 mm) and large group (≧8 mm). There were 74.6% infants in the small group and 25.4% in the medium group initially. The neonates in the initial small group would always see their IAS close or else they would remain in the small group. Those in the final medium and large size groups always came from the initial medium group. The late closure rate of IAS was 93.9% of infants with initial IAS. The closure curves of initial small and medium sized groups were significantly different, and their late closure rates were 95.1% and 90.4%, respectively.

Conclusions

IAS was very common during early neonatal stage, but most cases would close after 1 year. The late closure rate of initial IAS was different if using a cutpoint of 5 mm.

Key Words:  echocardiography , interatrial shunt , neonate

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Shiraishi H , Ichihashi K , Kuramatsu T , et al.   Left-to-right shunt via the foramen ovale in the early neonatal period: evaluation by Doppler color flow mapping . J Cardiol . 1987;17:559–566
  2. Fukazawa M , Fukushige J , Ueda K . Atrial septal defects in neonates with reference to spontaneous closure . Am Heart J . 1988;116:123–127
  3. Hannu H , Pentti K , Henrik E , et al.   Patency of foramen ovale: does it influence haemodynamics in newborn infants? . Early Hum Dev . 1989;20:281–287
  4. Hiraishi S , Agata Y , Saito K , et al.   Interatrial shunt flow profiles in newborn infants: a colour flow and pulsed Doppler echocardiographic study . Br Heart J . 1991;65:41–45
  5. Markhorst DG , Rothuis E , Sobotka-Plojhar M , et al.   Transient foramen ovale incompetence in the normal newborn: an echocardiographic study . Eur J Pediatr . 1995;154:667–671
  6. Senocak F , Karademir S , Cabuk F , et al.   Spontaneous closure of interatrial septal openings in infants: an echocardiographic study . Int J Cardiol . 1996;53:221–226
  7. Hansen LK , Oxhoj H . High prevalence of interatrial communications during the first three months of life . Pediatr Cardiol . 1997;18:83–85
  8. Connuck D , Sun JP , Super DM , et al.   Incidence of patent ductus arteriosus and patent foramen ovale in normal infants . Am J Cardiol . 2002;89:244–247
  9. Guntheroth WG , Schwaegler R , Trent E . Comparative roles of the atrial septal aneurysm versus patent foramen ovale in systemic embolization with inferences from neonatal studies . Am J Cardiol . 2004;94:1341–1343
  10. Ozcelik N , Atalay S , Tutar E , et al.   The prevalence of interatrial septal openings in newborns and predictive factors for spontaneous closure . Int J Cardiol . 2006;108:207–211
  11. Radzik D , Davignon A , van Doesburg N , et al.   Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life . J Am Coll Cardiol . 1993;22:851–853
  12. Lev M , Arcilla R , Rimoldi HJ , et al.   Premature narrowing or closure of the foramen ovale . Am Heart J . 1963;65:638–647
  13. Hanslik A , Pospisil U , Salzer-Muhar U , et al.   Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study . Pediatrics . 2006;118:1560–1565
  14. Wang N-K , Shen C-T , Lin M-S . Results of echocardiographic screening in 10,000 newborns . Acta Paediatr Tw . 2007;48:7–9
  15. Fisher DC , Fisher EA , Budd JH , et al.   The incidence of patent foramen ovale in 1,000 consecutive patients: a contrast transesophageal echocardiography study . Chest . 1995;107:1504–1509
  16. Meier B , Lock JE . Contemporary management of patent foramen ovale . Circulation . 2003;107:5–9
  17. El Said HG , McMahon CJ , Mullins CE , et al.   Patent foramen ovale morphology and impact on percutaneous device closure . Pediatr Cardiol . 2005;26:62–65
  18. Hagen PT , Scholz DG , Edwards WD . Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts . Mayo Clin Proc . 1984;59:17–20
  19. Cayler GG . Spontaneous functional closure of symptomatic atrial septal defects . N Engl J Med . 1967;276:65–73
  20. Cockerham JT , Martin TC , Gutierrez FR , et al.   Spontaneous closure of secundum atrial septal defect in infants and young children . Am J Cardiol . 1983;52:1267–1271
  21. Sherman FS , Sahn DJ , Valdes-Cruz LM , et al.   Two-dimensional Doppler color flow mapping for detecting atrial and ventricular septal defects: studies in an animal model and in the clinical setting . Herz . 1987;12:212–216
  22. Oberhoffer R , Lang D . Diagnostic criteria of interatrial defects: a single gate pulsed Doppler echocardiographic study . Int J Cardiol . 1989;25:167–171
  23. Riggs T , Sharp SE , Batton D , et al.   Spontaneous closure of atrial septal defects in premature vs. full-term neonates . Pediatr Cardiol . 2000;21:129–134

PII: S1875-9572(09)60017-6

doi:10.1016/S1875-9572(09)60017-6

Pediatrics & Neonatology
Volume 49, Issue 6 , Pages 234-239, December 2008

Article Tools