ECHOCARDIOGRAPHIC ASSESSMENT OF ASD TYPES AND SIZE WITH RIGHT HEART DILATATION IN TERTIARY CARE HOSPITAL PESHAWAR

Abstract

Background: Atrial septal defect (ASD) is one of the most common congenital heart defects and results in abnormal communication between the atria, most commonly producing a left-to-right shunt. Persistent shunting may cause right atrial and right ventricular volume overload, leading to right heart dilatation. Echocardiography plays an important role in identifying the type and size of ASD and assessing its hemodynamic effects.Objective: To determine the types and sizes of atrial septal defects using echocardiography and to assess their association with right heart dilatation among patients presenting to a tertiary care hospital in Peshawar.Methods: A cross-sectional study was conducted using echocardiographic records of 384 patients diagnosed with ASD at Lady Reading Hospital, Peshawar. Patients aged 1 day to 20 years with complete echocardiographic records were included. Data regarding age, gender, ASD type, ASD size, shunt direction, and right heart dilatation were collected using a pre-designed data collection form. Data were analyzed using SPSS version 26. Descriptive statistics were used for demographic and echocardiographic characteristics, while chi-square test, independent samples t-test, and one-way ANOVA were used to assess associations and differences. A p-value <0.05 was considered statistically significant. Results: Among 384 patients, 207 (53.9%) were male and 177 (46.1%) were female. The mean age was 35.11 ± 65.83 months, with an age range of 0.06–240 months. Secundum ASD was the most common type, accounting for 366 (95.3%) cases, followed by Primum ASD in 14 (3.6%) and Sinus Venosus ASD in 4 (1.0%) cases. The mean ASD size was 6.34 ± 5.90 mm. Left-to-right shunting was the predominant shunt direction, occurring in 347 of 383 valid cases. Right heart dilatation was present in 177 (46.1%) patients, while 207 (53.9%) had no dilatation. There was a statistically significant association between ASD type and right heart dilatation (χ² = 14.175, df = 2, p = 0.001). ASD size also differed significantly among ASD types (F = 4.931, p = 0.008). No statistically significant association was found between gender and ASD type (p = 0.494).Conclusion: Secundum ASD was the predominant ASD type in this study, and nearly half of the patients demonstrated right heart dilatation on echocardiography. Significant associations were observed between ASD type and right heart dilatation, as well as between ASD type and ASD size. These findings highlight the importance of echocardiography in characterizing ASD and identifying right heart remodeling, which may assist in timely clinical assessment and management.

Keywords: Atrial septal defect; echocardiography; right heart dilatation; secundum ASD; ASD size; congenital heart disease; children; Peshawar.