Predictors of Heart Failure in Nigerian Children with Ostium Secundum Atrial Septal Defects and Associated Structural Defects

Main Article Content

Chika O. Duru
Josephat M. Chinawa

Abstract

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions.

Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size=<5 mm, moderate size=5-9mm and large size=≥10 mm. The modified Ross Classification was used to determine the presence of heart failure. Data were analyzed using SPSS v 25.0 software.

Results: The ages of the children ranged from 0.25 months to 242 months with a mean age of 3.2±1.7 months and a male: female ratio of 1.5:1. Forty (53.3%) children had isolated os-sec ASD while 35 (46.7%) children had os-sec ASD with other structural defects. Thirty-eight (50.7%) of the children had features of heart failure at presentation out of which 50% were infants and 88.0% were mildly wasted. There was no significant association between the presence of heart failure in the study subjects and age, gender or nutritional status (p> 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD.

Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.

Keywords:
Heart failure, prevalence, predictors, atrial septal defects, children

Article Details

How to Cite
Duru, C. O., & Chinawa, J. M. (2020). Predictors of Heart Failure in Nigerian Children with Ostium Secundum Atrial Septal Defects and Associated Structural Defects. Cardiology and Angiology: An International Journal, 9(4), 20-27. https://doi.org/10.9734/ca/2020/v9i430143
Section
Original Research Article

References

Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation. 2006;114;1645–1653.

Porter CBJ, Edwards W. In: Moss and Adam’s Heart Disease in infants, Children and Adolescents. Allen HD, Driscol DJ, Shaddy RE, Feltes TF, editors. Philadelphia: Lippincott William S Wilkins. 2008:632–645.

Le Gloan L, Legendre A, Iserin L, Ladouceur M. Pathophysiology and natural history of atrial septal defect. J Thorac Dis. 2018;10:2854‐2863.

Fuse S, Tomita H, Tomita H, Hatakeyama K, Kubo N, Abe N. Effect of size of a secundum atrial septal defect on shunt volume. Am J Cardiol. 2001;88: 1447-1450.

Levin AR, Spach MS, Boineau JP, Canent Jr RV, Capp MP, Jewett PH. Atrial pressure flow dynamics in atrial septal defects (secundum type). Circulation. 1968;37:476-488.

Geva T, Martins JD, Wald RM. Atrial septal defects. Lancet. 2014;383:1921-1932.

Campbell M. Natural history of atrial septal defect. Br Heart J. 1970;32:820-826.

Wiktor DM, Carroll JD. ASD Closure in Structural Heart Disease. Curr. Cardiol. Rep. 2018;20:37.
Available:https://doi.org/10.1007/s11886-018-0983-x

Andrews R, Tulloh R, Magee A Anderson D. Atrial septal defect with failure to thrive in infancy: Hidden pulmonary vascular disease? Pediatr Cardiol. 2002;23:528- 530.

Bostan OM, Cil E, Ercan I. The prospective follow-up of the natural course of interatrial communications diagnosed in 847 newborns. Eur Heart J. 2007;28:2001–2005.

Behjati-Ardakani M, Golshan M, Akhavan-Karbasi S, Hosseini S, Behjati-Ardakani M, Sarebanhassanabadi M. The Clinical Course of Patients with Atrial Septal Defects. Iran J Pediatr. 2016;26:46-49.

Ekure EN, Bode-Thomas F, Sadoh WE, Orogade AA, Otaigbe BE, Ujunwa F et al. Congenital Heart defects in Nigerian Children: Preliminary Data from the National Pediatric Cardiac registry. World J Pediatr Congenit Heart Surg. 2017;8:699-706.

Ejim EC, Anisiuba BC, Ike SO, Essien IO. Atrial septal defects presenting initially in adulthood: patterns of clinical presentation in Enugu, South-East Nigeria. J Trop Med; 2011.
DOI: 10.1155/2011/251913

Ross RD. The Ross Classification for heart failure in children after 25 years: A Review

and an age-Stratified Revision. Pediatr Cardiol. 2012;33:1295-300.

WHO Anthro Survey Analyser-World Health Organization.
Available:https://www.who.int/nutgrowthdb/about/anthro-survey-analyser-quickguide.pdf?ua=1
Assessed on 30/05/2020.

Okoromah CAN, Ekure EN, Lesi FEA, Foluso EA, Okunowo WO, Tijani BO et al. Prevalence, Profile and predictors of malnutrition in children with congenital heart defect: a case-control observational study. Arch Dis Child. 2011;96:354-360.

Saxena A, Divekar A, Soni NR. Natural history of secundum atrial septal defect revisited in the era of transcatheter closure. Indian Heart J. 2005;57:35-38.

Bissessor N. Current perspectives in percutaneous atrial septal defect closure devices. Med. Devices. 2015;8:297–303.

Rao PS, Harris, AD. Recent advances in managing septal defects: Atrial septal defects. F1000 Faculty Rev. 2017;6:2042.
DOI: 10.12688/f1000.11844.1

Sachweh JS, Daebritz SH, Hermanns B, Fausten B, Jockenhoevel S, Handt S. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg. 2006;81:207-213.

Magoon R, Choudhury A, Karanjkar A, Singh U. Early onset of cyanosis in a patient with atrial septal defect: Transesophageal echocardiography reveals the underlying mechanism. Annals of Cardiac Anaesthesia. 2018;21:287-289.