Predictors of Heart Failure in Nigerian Children with Ostium Secundum Atrial Septal Defects and Associated Structural Defects

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions.

Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size=<5 mm, moderate size=5-9mm and large size=≥10 mm. The modified Ross Classification was used to determine the presence of heart failure. Data were analyzed using SPSS v 25.0 software.

Results: The ages of the children ranged from 0.25 months to 242 months with a mean age of 3.2±1.7 months and a male: female ratio of 1.5:1. Forty (53.3%) children had isolated os-sec ASD while 35 (46.7%) children had os-sec ASD with other structural defects. Thirty-eight (50.7%) of the children had features of heart failure at presentation out of which 50% were infants and 88.0% were mildly wasted. There was no significant association between the presence of heart failure in the study subjects and age, gender or nutritional status (p> 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD.

Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.