الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
An ostium secundum atrial septal defect is an abnormally large opening in the atrial septum at the site of the foramen ovale and the ostium secundum. A secundum atrial septal defect can result from inadequate formation of the septum secundum so that it does not completely cover the ostium secundum. More often, the ostium secundum is excessively large because of increased resorption so that septum secundum cannot cover it. Isolated secundum atrial septal defects account for approximately 7% of congenital cardiac defects. Congenital heart defects of significance occur in approximately 8 per 1000 live births. Therefore, 5-6 cases of secundum atrial septal defect occur per 10,000 live births. This number refers only to defects that are large enough to come to clinical attention. Many small defects that remain undetected occur in addition to numerous cases of patent foramen ovale, An isolated secundum atrial septal defect very seldom causes significant symptoms in pediatric patients, regardless of defect size.
Rarely, an infant may develop congestive heart failure in the presence of a secundum atrial septal defect Whether the defect alone is responsible for causing heart failure is not well established, although it certainly adds to the patient’s hemodynamic difficulties. Failure to thrive caused only by a secundum atrial septal defect is, similarly, a rare occurrence. Anumber of studies including the present one were conducted to determine whether a true association or a causal role of ostium secundum atrial septal defect exists in the production of mitral valve prolapse. forty five children with a well documented history of congenital heart disease, including 19 males and 26 females, ages 2 to 12 years (mean 4.02± 2.08 years ). This group of children was selected from those who attend the cardiology outpatient clinic in El-Shatby Hospital for follow up.
The diagnosis of a secundum type ASD is usually based on certain well described features derived from auscultation, EKG interpretation and echocardiography.
All studied children were subjected to:
1. Thorough history taking: including , age, sex and residence. History of congenital heart disease was inquired about. The diagnosis was made by echocardiography. A past history of any relevant medical disorder was also inquired about.
2. Thorough clinical examination including chest, heart and abdominal examination with special emphasis on local cardiac findings.
3. Conventional 12-lead electrocardiography.
4. Full echocardiographic study.
Each individual was examined with a commercially available GE Vivid 3 Echo system with 3.o-MHz and 5.oMHz probes. The following criteria were utilized to assess mitral valve prolapse (MVP) on two dimensional echocardiography.
Two-Dimensional examination: both parasternal long axis and apical four chamber views were done and MVP graded as 1 if the coaptation point of the 2 leaflets was at the ventricular side of the annulus, 2 if it was at the annulus, and 3 if it was at the atrial side of the annulus. Also, it was noted whether one leaflet or both leaflets prolapse was present where possibilities entailed prolapse of anterior leaflet, prolapse of posterior leaflet or prolapse of both leaflets. The present study revealed a prevalence of twenty percent of mitral valve prolapse among the studied cases of ostium secundum ASD. All of them had anterior leaflet prolapse. Grade I prolapse was found in six cases, Grade II in three cases and grade III was not detected. The presence of prolapse not proved to be significantly associated with the degree of incompetence. It can be concluded that there is a causal relation between ostium secundum ASD and MVP. The prolapse produced in these cases is a functional in origin due to atrial shunt and left ward shift of interventricular septum and is to be differentiated from congenital type. Also the presence of MVP in conjunction with ostium secundum ASD does not increase the morbidity or risks of complications and affect surgical decision.