Atrial septal defects in Iceland.

Atrial septal defects (ASD) are common congenital heart defects (CHD), 15-22% of all CHD. The diagnosis of ASD is often delayed due to nonspecific symptoms and faint heart murmur and needs confirmation by echocardiography (2 DE). The aim of our study is to study the incidence of ASD, associated defects, and operative results in patients in our population of 260,000. We reviewed the medical records of all patients diagnosed in Iceland with the diagnosis of ASD born in 1984-93. There were 43,809 births during that period. The ASD was confirmed by 2DE in all patients and smaller defects than 4 mm were excluded. There were 87 patients, 61 female and 26 male; male/female = 1:2,4. The number of patients increased during the period; 1984-85 four patients, 1986-87 12 patients, 1988-89 19 patients, 1990-91 22 patients and 1992-93 30 patients. The incidence in 1984-85 was 0.5/1000 and in 1992-93 2.6/1000. The ASD types were: ASD secundum 79 patients, ASD primum three patients and sinus venosus ASD five patients. The symptoms that lead to cardiac evaluation were most often heart murmur with (22%) or without (62%) other symptoms. However 16% of the patients did not have murmur as a referral diagnosis. There were 26 (30%) patients with other congenital anomalies (Down's syndrome eight patients, other chromosomal defects three patients, 15 patients with other congenital defects) and 29 (33%) patients also had a minor cardiac defect. Four patients died, all from other causes than the cardiac defect, none of whom had been operated. There were 34 (39%) patients who will or have already been operated, in 29 (33%) patients the ASD has closed spontaneously and in 12 (14%) patients the ASD size had decreased so there was no need for an operation. There were no deaths from operation and one patient had a minor complication. In conclusion ASD is a more common problem in childhood than previously reported and often these patients have significant associated problems. Vague symptoms and often inconspicuous heart murmur often delay diagnosis. The surgery for ASD is safe and longterm prognosis favorable.