Arq Bras Cardiol: Imagem cardiovasc 2025; 38(2): e20240089

Classifying the Size of an Atrial Septal Defect According to Echocardiographic Parameters and its Association with the Clinical Presentation in Pediatrics

Lívia de Castro

Ribeiro

, Rose Mary Ferreira Lisboa da

Silva

, Henrique de Assis Fonseca

Tonelli

, Adriana Furletti Machado

Guimarães

, Fátima Derlene da Rocha

Araújo

, Zilda Maria Alves

Meira

, Sandra Regina Tolentino

Castilho

, Alan Alvarez

Conde

, Lícia Campos

Valadares

DOI: 10.36660/abcimg.20240089i

Abstract

Background

Few studies are using linear echocardiographic measurements for classifying the size of Atrial Septal Defect (ASD).

Objectives

Investigate the relationship between ASD hemodynamic repercussions and ASD diameter to the mitral annulus diameter (MI/ASD) ratio and ASD diameter to the interatrial septum diameter (ASD/septum) ratio, and describe cutoff points to classify the size of the defect.

Methods

An observational, prospective, cross-sectional study, including subjects aged 1 month and 18 years diagnosed with isolated ASD. Hemodynamic repercussion was quantified by clinical evaluation, tricuspid annulus (TA) Z-score, subjective estimation of the enlargement of the right chambers, and the relationship between systemic and pulmonary flows (QP/QS) on echocardiography. Its association with ASD/septum and MI/ASD measurements was also studied. A value of p < 0.05 was considered statistically significant.

Results

Thirty-five subjects, mean age 6.3 years, 69% female, mean ASD 13.5 mm. There was a correlation between MI/ASD and the clinical classification of ASD (Pearson: -0.61; p < 0.001), ASD/septum (Pearson: -0.80; p < 0.001), and QP/QS (-0.76; p < 0.001). There was a correlation between ASD/septum and the clinical classification of ASD (Pearson: 0.56; p < 0.001), QP/QS (0.63; p = 0.001), subjective assessment of the right chambers (0.62; p < 0.001), and a weak correlation with the TA Z-score (0.35; p = 0.04). According to the operating characteristic curve for the stable variable classification of ASD according to the subjective right chamber’s size, an area of 0.85 was obtained for ASD/septum (p = 0.001). The cutoff point of 0.27 for large ASD showed sensitivity of 85%, specificity of 86.7%, positive predictive value (PPV) of 86%, negative predictive value (NPV) of 85.2%, and positive likelihood ratio of 6.39.

Conclusions

ASD/septum was associated with the hemodynamic repercussion of ASD and was useful in detecting large ASD.