Coexistent Atrial and Ventricular Septal Defects: A Report of Twenty-two Cases

Abstract

Twenty-two cases of coexistent atrial (ostium secundum) and ventricular septal defects have been reviewed. The clinical course generally was similar to that of patients with large isolated ventricular septal defects. Likewise, the auscultatory findings commonly resembled those associated with a large isolated ventricular septal defect, except that the diastolic flow murmur was diffusely located from left sternal border to apex. The electrocardiogram typically showed evidence of right atrial enlargement, right or biventricular hypertrophy, and an rsR' pattern in the right precordial leads. Roentgenograms were characterized by cardiomegaly, prominent pulmonary artery segment, and increased pulmonary vascular markings, but with no sign of left atrial enlargement. With few exceptions, pulmonary hypertension and large left-to-right shunts were demonstrated at cardiac catheterization, with a significant shunt at the atrial level being found in all but one case. Selective angiocardiography was of great value in delineating the two defects. Although the atrial defect was usually located in the fossa ovalis and the ventricular defect was usually large and in the membranous area, there was variation in the size and location of defects, and in their combinations. Of the 19 patients undergoing corrective surgery, 12 survived, including two infants.