Læknablaðið - 15.03.1996, Blaðsíða 30

220
LÆKNABLAÐIÐ 1996; 82
Op á milli gátta
hjá íslenskum börnum
Hróðmar Helgason, Guðbjörg Jónsdóttir
Helgason H, Jónsdóttir G
Atrial septal defects in Iccland
Læknablaðið 1996; 82: 220-6
Atrial septal defects (ASD) are common congenital
heart defects (CHD), 15-22% of all CHD. The diag-
nosis of ASD is often delayed due to nonspecific
symptoms and faint heart murmur and needs confir-
mation 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 pop-
ulation 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 pa-
tients 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 in-
creased 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 eval-
uation were most often heart murmur with (22%) or
without (62%) other symptoms. However 16% of
the patients did not have murmur as a referral diag-
nosis. There were 26 (30%) patients with other con-
genital anomalies (Down’s syndrome eight patients,
other chromosomal defects three patients, 15 pa-
tients with other congenital defects) and 29 (33%)
patients also had a minor cardiac defect. Four pa-
tients 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
Frá Barnaspítala Hringsins, Landspítalanum. Fyrirspurnir,
bréfaskipti: Hróðmar Helgason, Barnaspítala Hringsins,
Landspitalanum, 101 Reykjavík.
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.
Ágrip
Op á milli gátta (atrial septal defect, ASD)
er algengur hjartagalli og talinn næst algengasti
hjartagallinn. Til skamms tíma hefur op á niilli
gátta aðallega greinst í fullorðnu fólki enda
klínísk einkenni oft lítil á barnsaldri. Tilgangur
rannsóknarinnar var að athuga nýgengi og
greiningu hjartagallans hjá börnum, tengda
fæðingargalla, árangur aðgerða og langtíma-
horfur.
Farið var yfir sjúkraskrár og ómskoðanir
allra barna fædd á árunum 1984-93. Op undir 4
mm voru ekki tekin með. Ómrannsókn lá fyrir
hjá öllum sjúklingunum. Það greindust 87 börn
með op á milli gátta á Islandi, 61 stúlka og 26
drengir, kynjahlutfall 2,4:1. Fjöldi greindra
sjúklinga fór vaxandi allt tímabilið: Fjögur
börn 1984-85, 12 börn 1986-87, 19 börn 1988-
89, 22 börn 1990-91 og 30 börn 1992-93. Þegar
líffærafræðileg gerð opanna var athuguð voru
79 börn (91%) með secundum op á milli gátta,
þrjú börn (4,5%) voru með primum op á milli
gátta og þrjú (4,5%) með sinus venosus op á
niilli gátta.
Það einkenni sem leiðir til greiningar er oft-
ast hjartaóhljóð með (22%) eða án (62%) ann-
arra einkenna. Hins vegar voru 16% barnanna
ekki með hjartaóhljóð. Af þessum 87 börnum