Objective: To reveal diagnostic features in atrial septal defect (ASD) in different age groups; to define a role of X-ray study in the diagnosis of ASD.
Material and methods: Forty-eight patients (16 men and 32 women) aged 15 to 71 years with ASD at different sites were examined. All the patients underwent chest X-ray, echocardiography, and cardiac phase-contrast magnetic resonance imaging (MRI). The examinees were divided into 2 age groups: 1) less than 40 years (n = 18) and 2) more than 40 years (n = 30). The groups were compared using quantitative and alternative signs and they did not significantly differ in the volume of intracardiac shunt and in the size of the defect. The X-ray and MRI indicators reflecting the calibers of pulmonary arteries were also compared in patient groups with different pulmonary artery systolic pressures (PASP) (< 35, 36-60, and > 60 mm Hg).
Results: The older age group more frequently showed signs of heart failure, valvular regurgitation, and an atypical X-ray pattern. The sizes of atria, pulmonary artery and its branches, and PASP were also increased in the older age group. The patient group with high PASP (> 60 mm Hg) significantly differed from the others in all the indicators analyzed. Normal PASP and moderate pulmonary hypertension groups greatly differed only in the Moore index.
Conclusion: Chest X-ray reflects rather precisely the hemodynamic type of the defect. High pulmonary hypertension has clear X-ray and MRI manifestations. The specificity of X-ray in the diagnosis of PASP is lower in the older age group due to the higher rate of an atypical X-ray pattern. Radiology is important in detecting pulmonary venous hypertension in patients with PASP. Pulmonary venous hypertension is indicative of elevated pressure in the left atrium and pulmonary veins and arises from different causes: shunt inversion, restrictive defect, mitral valve comorbidity, and left ventricular systolic and diastolic dysfunction.