Spontaneous Closure Of An Atrial Septal Defect

Abstract

Spontaneous functional closure of large atrial septal defects was demonstrated by cardiac catheterization and cineangiographic technics in 3 infants. These 3 patients and 1 other with clinical evidence of spontaneous closure constitute 31% (4 of 13) of infants with acyanotic congenital heart disease and large secundum atrial septal defects studied at the Sutter Memorial Hospital in the past four years (1962-1966). Disappearance of large atrial left-to-right shunts was documented between the ages of seven days and fifteen months (Case 1), three weeks and eight months (Case 2) and three months and twenty months (Case 3). Case 1 had an associated moderate-sized ductus and aortic stenosis, Case 2 an associated small ductus, and Case 3 no other cardiovascular anomaly. The possible mechanisms of spontaneous closure are discussed. The demonstration of spontaneous disappearance of large atrial left-to-right shunts supports a conservative approach to early surgical closure of atrial septal defects even in patients with large left-to-right shunts, cardiac enlargement and congestive heart failure. The spontaneous closure of atrial septal defects associated with complicated cyanotic cardiac anomalies has not been documented but probably occurs and obviously could have a profound effect on the natural history of such lesions.