Atrial Septal Defects Presenting Initially in Adulthood: Patterns of Clinical Presentation in Enugu, South-East Nigeria

This paper aimed to evaluate the patterns of clinical presentation of adults with atrial septal defects (ASDs) who were diagnosed from transthoracic echocardiographic examination at the echocardiographic laboratory of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria, from February 2002 to June 2010. 2251 new echocardiogram scans, with additional 373 repeat scans, were done within the period. 32 adults had ASDs (1.3%), made up of 9 males and 23 females. Secundum ASD constituted 75% while dyspnoea on exertion was the commonest symptom. Congestive cardiac failure was the clinical syndrome most commonly encountered, and most patients presented in the third decade. This paper demonstrated that ASDs are common congenital heart diseases in adult Nigerians, and that they are important causes of congestive heart failure. All adults with congestive heart failure must be referred for echocardiography for early identification of causes like ASDs, which are often forgotten, before the development of irreversible changes in the lungs. 1. Introduction In the developed countries, more than 95% of children with congenital heart defects reach adulthood currently [1]. In Europe, the number of adults with congenital heart disease is estimated to be at least 1.2 million, and despite major developments in diagnostic methods and treatment of congenital heart disease, cure is rarely achieved [2, 3]. Atrial septal defect (ASD) is one of the most common congenital heart defects in adults [4, 5]. ASD patients can present at any age, and females constitute 65–75% of patients with the secundum type while the gender distribution is equal for sinus venosus and ostium primum types [6, 7]. Exercise intolerance is the most common initial presenting symptom while palpitation, features of decompensated heart failure, paradoxical embolus, or cyanosis may also be the presenting feature [6]. The authors are not aware of any studies reporting prevalence of atrial septal defects in adults or the pattern of presentation of these patients in sub-Saharan African. In low-income settings like in most sub-Saharan African countries, echocardiography is not readily available and/or affordable. It then becomes important that clinicians recognize the clinical features of these conditions and make prompt referrals before the development of irreversible changes in the lungs and heart. 2. Materials and Methods The University of Nigeria Teaching Hospital (UNTH) Enugu, Enugu State, is a 700-bed tertiary hospital in South-East Nigeria. Within the period under review, it provided