Familial incidence of atrial septal defect. A report of four siblings and review of the literature

Atrial septal defect in adult identical twins: a variation in theme

The diagnosis of atrial septal defect was established in monozygotic twin females at age 63. Each patient mimicked a different acquired heart disease. One twin had congestive heart failure and atrial fibrillation and was diagnosed as having rheumatic mitral insufficiency. The other twin had atypical chest pain and systemic hypertension and was thought to have arteriosclerotic heart disease. In each case the correct diagnosis was made at cardiac catheterization. Although the same basic congenital heart lesion was present in both patients, the symptoms and findings differed. Symptomatic improvement was achieved by different therapeutic modalities. One patient had open heart surgery, while the other twin improved with medical therapy.

Familial atrial septal defect with prolonged atrioventricular conduction

This report describes a family with frequent recurrence of congenital heart disease in multiple generations. Eight members had atrial septal defect (ASD) of the fossa ovalis type and seven members had other forms of congenital heart disease. One branch of the pedigree showed a predominance of ASD with prolonged atrioventricular (A-V) conduction and initially suggested an autosomal dominant gene effect. A variety of other forms of congenital heart disease were found in several first degree relatives of those with ASD as well as in more distant relatives. The variability of congenital heart disease in this pedigree is compatible with the polygenic mode of inheritance. Definition of the inheritability of congenital heart disease in a specific family has important consequences in the determination of the recurrence risks for all family members.

Continuous positive airway pressure in the prophylaxis of the adult respiratory distress syndrome (ARDS)

Alternate patients believed to be at risk for developing ARDS were placed on CPAP for the first twenty-four hours post upper abdominal surgery. Ten of the 58 controls developed ARDS, requiring prolonged mechanical ventilation with a 30% mortality rate. Only one of the 59 CPAP patients developed evidence of ARDS. This patient, however, is believed to have had fluid overload, and responded quickly to diuretics and was extubated within two days. Thus, prophylactic CPAP has greatly decreased our postoperative morbidity and mortality related to respiratory causes.