Spontaneous Closure Of A Secundum Atrial Septal Defect
Wang, S. Y., Welch, T. D., Elfenbein, A., & Kaplan, A. V. (2018). Spontaneous Closure of a Secundum Atrial Septal Defect. Methodist DeBakey cardiovascular journal, 14(1), 60–62. https://doi.org/10.14797/mdcj-14-1-60
View Original Source →Abstract
Spontaneous closure of an atrial septal defect (ASD) is well described in pediatric cardiology but may be less familiar to adult internists and cardiologists. We report a moderately sized 6-mm ASD that closed spontaneously without intervention. A literature review found that a smaller defect size and an early age of diagnosis are the most important predictors of closure. Possible mechanisms of a spontaneous ASD closure include adaptive endothelial migration, limited myocardial proliferation, and fibroblast migration with extracellular matrix deposition.
Case Details
Disease Location
Heart
Personal Characteristics
Newborn girl at diagnosis 18 year old at remission
Clinical Characteristics
Heart murmur within the first 24 hours of life. Cardiac auscultation at 3 days of life revealed a grade 3/6, somewhat high-pitched holosystolic murmur at the left lower sternal border radiating throughout the precordium. There was also a systolic murmur over both posterior lung fields. The electrocardiogram was normal except for nonspecific st- and t-wave changes. Tte showed a moderately sized secundum asd measuring 6 mm in diameter and a single anterior apical vsd measuring 5 mm. The patient presented at the age of 18 with a complaint of “heart hurting” beginning 2 to 3 months before evaluation. Echocardiogram demonstrated a structurally normal heart with a patent foramen ovale detected by agitated saline
Remission Characteristics
Upon physical examination at age 2, the cardiac murmur could no longer be heard. Transesophageal echocardiogram was performed to verify spontaneous and complete closure of the secundum asd
Treatment & Mechanisms
Proposed Remission Mechanisms
Shear stress and blood flow dynamics vs myocardial proliferation vs fibroblast migration and extracellular matrix deposition