Atrial septal defect in children.

This paper has a two-fold purpose: first, to present the signs and symptoms of atrial septal defect and thus outline the findings that help in making the clinical diagnosis, and secondly, to show that correct and early diagnosis is important, because this anomaly gives rise to serious, although frequently obscured, symptoms and disabilities more often than has been generally realized. Clinically, atrial septal defect may be defined as a developmental anomaly of the atrial septum that permits a shunt of blood between the two atria. Over 300 cases of atrial septal defect have been recorded in the period 1765-1954. The first mention of a case was probably in a report by Morgagni (1765). This was followed by several reports during the nineteenth century (Corvisart, 1811; Louis, 1826; Ecker, 1839; Mayne, 1848; Peacock, 1860; Martineau, 1865; Rokitansky, 1875). When, in 1934, Roesler collected all the cases (as he thought) previously described, adding one of his own, a total of 62 had been reached. Since then the reporting of such cases has avalanched. Thus, in 1940, Tinney reviewed 24 cases from 1934-1938, Bedford et al. 53 in 1941, Cosby and Griffith 35 in 1949, and at least 200 other examples have been put on record. The clinical diagnosis of this condition had not been well established until recently, and even now many features are disputed. With the introduction of special techniques of investigation, notably cardiac catheterization and angiocardiography, the diagnosis in life is more firmly established than before. At the same time, correlation of these investigations with the clinical findings has provided an objective check on the clinical diagnostic criteria. With the advance in cardiac surgery, which has led to several techniques for atrial septal closure, precision in diagnosis has become essential. Satisfactory clinical criteria are necessary to select cases for additional studies, such as cardiac catheterization. With these problems in mind we have reviewed the clinical profiles of 133 children with atrial septal defect.