Andersons pediatric cardiology 766
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InteratrialCommunications
AndrewN.Redington,RobertH.Anderson,DianeE.Spicer
Abstract
Thischapterdiscussesthefeaturesofinteratrialcommunications.Theterm
“interatrialcommunications”isusedinthischapterbecausenotallthe
channelsthatpermitshuntingbetweentherightandleftatriumarewithin
theconfinesoftheatrialseptum.Inthisregard,wedefinea“septum”asa
partitionthatcanberemovedwithoutexitingfromthecavitiesofthe
cardiacchambersthemselves.Tomakeuseofthisdefinition,webeginby
definingtheextentoftheatrialseptumasthusdefined.Itisconfinedtothe
flooroftheovalfossaanditsanteroinferiorbuttress.Theremainingrimsof
thefossaareinfoldingsoftheatrialwalls.Channelsthataretrueseptal
defectsarefoundwithintherimsofthefossa,alongwiththerarevestibular
defect,whichextendsthroughtheanteroinferiorbuttress.Theotherlesions
thatpermitinteratrialshunting,namelythesinusvenosusdefects,the
coronarysinusdefect,andtheostiumprimumdefect,areallfoundoutside
theconfinesofthenormalseptum.Havingdefinedtheanatomyand
morphogenesisofthesedefects,wediscussalltherelevantclinicalfeatures.
Weemphasisethefeaturesthatpermittheirechocardiographicdiagnosis
anddiscusstheoptionsformanagement.Thosebornwithinteratrial
communications,subsequenttoappropriaterepair,shouldbeableto
anticipateleadingavirtuallynormallife.
Keywords
atrialseptaldefect;sinusvenosusdefect;coronarysinusdefect;oval
fossadefect;vestibulardefect;patentovalforamen
Introduction
Channelspermittingshuntingbetweentheatrialchambersareimportant
congenitalcardiacanomaliesbecausetheyarerelativelycommonandaremore
nearlycompletelycorrectablethanmostothercardiacmalformations,evenmore
sointheeraofcatheterintervention.Itmaybedifficult,nonetheless,todiagnose
thepresenceofsuchcommunications,andoftenthereisnosuspicionofcardiac
diseaseduringinfancyandearlychildhood.Moreover,theanatomicarrangement
maybemorecomplexthanameredeficiencyoftheflooroftheovalfossa.
Anatomicfeaturesunderscorethespecificdescriptionoftheselesionsas
interatrialcommunicationsratherthanthemoreusualreferenceto“atrialseptal
defects.”Thesubtledifferencesbetweentrueatrialseptaldefectsandinteratrial
communicationsareemphasizedintheinitialsection,devotedtomorphology.
Thelackofearlysymptomscoupledwiththeaddedsubtletyofthephysical
findingscandelaythediagnosis,sometimesuntilwellintoadultlifeoreven
untilmiddleoroldage.Nonetheless,aclinicaldiagnosiscanstillbemadeonthe
basisofameticulouscardiacphysicalexamination.Thechestradiographand
electrocardiogramusuallysupportsuchdiagnosis,butechocardiographyand
Dopplerstudiesarediagnosticinvirtuallyallcases.Therapeuticintervention
duringchildhood,afterdocumentationofanimportantshuntatatriallevel,
shouldnowresultinanormallifeexpectancy,freeofcardiacmorbidity.With
theincreasinguseoftranscatheterdevices,thiscannowfrequentlybeachieved
withouttheneedforsurgery.
