ATRIAL SEPTAL DEFECT IN CHILDREN

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Abstract
This paper reviews the history, physical examination, X-ray findings and ecgs of 133 children with atrial septal defect and without other congenital defects in whom the authors felt the diagnosis was well defined. The two outstanding symptoms were breathlessness (65 cases) and frequent chest infections (70 cases). The physical signs which were most frequent were: enlargement of the heart involving mainly the right side (more than 1/3 of series); a loud, (often widely) split pulmonary second sound (all cases); a systolic murmur at the pulmonary area (97%), sometimes accompanied by a palpable thrill in this area (26%); and an apical diastolic murmur (30%). The ecgs (at least 3 standard limb and 3 unipolar precordial leads) in 120 patients were interpreted as being abnormal in 108 cases with right ventricular hypertrophy with or without complete or incomplete right bundle branch block occurring in 64 cases. X-ray findings and fluoroscopy showed right ventricular enlargement in 104 cases, prominent pulmonary conus in 101 cases, large pulsatile pulmonary arteries in 114 cases and increased vascularity of the lung fields in 102 cases. The authors were impressed by the lack of correlation between heart size and symptoms.