Characteristics of 11 Neonates with Atrial Septal Defects Detected by Heart Murmurs

ABSTRACT

The aim of this prospective study was to investigate, using echocardiography, the relationship between heart murmurs found in the neonatal period and atrial septal defect (ASD). Heart murmurs were detected in 115 of 5124 term neonates within 1 month after birth. The babies were followed by echocardiographic examination with attention to the atrial septal area. Heart murmurs of 11 term neonates (9.6%) were associated with interatrial shunts consistent with ASD. The defect closed spontaneously in 7 out of the 11 neonates by 18 months of age. Two neonates showed evidence of right ventricular overload from early infancy. This study showed that nearly 1 neonate in 10 with a heart murmur up to 1 month after birth had an interatrial shunt associated with ASD. We concluded that the absence of a flap sign (valve-like openings of the defects) affects the development of the heart murmur of ASD found in the neonatal period.

Heart murmur - echocardiography - atrial septal defect

REFERENCES

• 1 Cockerham J T, Martin T C, Gutierrez F R, Hartmann A F, Goldring D, Strauss A W. Spontaneous closure of secundum atrial septal defect in infants and young children.  Am J Cardiol . 1983;  52 1267-1271
• 2 Mahoney L T, Truesdell S C, Krzmarzick T R, Lauer R M. Atrial septal defects that present in infancy.  Am J Dis Child . 1986;  140 1115-1118
• 3 Fukazawa M, Fukushige J, Ueda K. Atrial septal defects in neonates with reference to spontaneous closure.  Am Heart J . 1988;  116 123-127
• 4 Riggs T, Sharp S E, Batton D, Hussey M E, Weinhouse E. Spontaneous closure of atrial septal defects in premature vs full-term neonates.  Pediatr Cardiol . 2000;  21 129-134
• 5 Grenadier E, Lima C O, Allen H D. Normal intracardiac and great vessel Doppler flow velocities in infant and children.  J Am Coll Cardiol . 1984;  4 34-50
• 6 Wilson N, Reed K, Allen H D, Marx G R, Goldberg S J. Doppler echocardiographic observations of pulmonary and transvalvular velocity changes after birth and during the early neonatal period.  Am Heart J . 1987;  113 750-758
• 7 Silverman N H. Interatrial communications. In: Pediatric Echocardiography Baltimore: Williams and Wilkins, Inc. 1993: 109-121
• 8 Takami T, Kawashima H, Kamikawa A. Prevalence of cardiac murmur detected on routine neonatal examination.  J Tokyo Med Univ . 2001;  59 290-293
• 9 Hannu H, Pentti K, Henrik E, Markku S, Ilkka V. Patency of foramen ovale: does it influence haemodynamics in newborn infants?.  Early Hum Dev . 1989;  20 281-287
• 10 Chatelain P, Oberhansli I, Friedli B. Physiological pulmonary branch stenosis in newborns: 2D-echocardiographic and doppler characteristics and follow up.  Eur J Pediatr . 1993;  152 559-563
• 11 Danilowicz D A, Rudolph A M, Hoffman J E, Heymann M. Physiologic pressure differences between main and branch pulmonary arteries in infants.  Circulation . 1972;  45 410-419
• 12 Evans N, Iyer P. Incompetence of the foramen ovale in preterm infants supported by mechanical ventilation.  J Pediatr . 1994;  125 786-792
• 13 Ghisla R P, Hannon D W, Meyer R A, Kaplan S. Spontaneous closure of isolated secundum atrial septal defects in infants: an echocardiographic study.  Am Heart J . 1985;  109 1327-1333
• 14 Oberhoffer R, Lang D. Diagnostic criteria of interatrial defects: a single gate pulsed doppler echocardiographic study.  Int J Cardiol . 1989;  25 167-171
• 15 Radzik D, Davignon A, Doesburg F N, Fournier A, Marchand F T, Ducharme G. Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life.  J Am Coll Cardiol . 1993;  22 851-885
• 16 Ainsworth S B, Wyllie J P, Wren C. Prevalence and clinical significance of cardiac murmur in neonates.  Arch Dis Child . 1999;  80 F43-F45