الفهرس 
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Abstract
Summary : br The present study had been performed at the paediatric department , out patient clinic , intermediate care unit , and neonatal intensive care unit (NICU) of Sohag university hospital , Upper Egypt through the period -#102;-#114;-#111;-#109; 1st of January 2012 to the end of January 2013. It included 65 patients at age -#102;-#114;-#111;-#109; birth to 18 years , of them 25 (38.6% ) were males ,while 40 (61.5%) were females with female predominance ; male to female ratio was [1: 1.6] . Their ages at presentation ranged -#102;-#114;-#111;-#109; 5 days to 13 years with Mean ± SD (2.27 ± 2.8 years). br Most of studied cases (49.2%) presented during infancy, and the majority of them were -#102;-#114;-#111;-#109; rural and semi-urban areas , the commonest detected risk factors among studied cases was positive consanguinity in (78%) . br br The majority of cases had ASDII (81.5 %) , followed by ASDI in (10.8%) , then combined ASD in (4.6%) , and sinus venosus type the less common in (3.1%) of cases . br Of the 65 patients ,(47.6%) were asymptomatic and discovered accidently during routine medical examination . The most frequent symptoms were reccurent chest infections in (36.9%) of patients , while the less frequent was permanent cyanosis i.e . Eisenmenger syndrome in 3 cases (4.6%) [ 2 cases of primum ASD - 1 case of combined ASD] , as for the most common signs , ejection systolic murmur was the commonest in (89. 2%) of cases , followed by wide fixed splitting of 2nd heart sound , and the less common was permanent cyanosis in (4.6%) of cases. br As for investigations , ECHO was the one of choice and revealed that size of the defect , ranged -#102;-#114;-#111;-#109; ( 1.5 - 23 mm) with mean ± SD (7.9 ± 4.7) , small defects (2 - 5 mm ) were the commonest . Pulmonary hypertension was elevated in (21.5%) of cases of them 3 suffered reversal of the shunt and developed Eisenmenger syndrome . br Chest x- ray demonstrated that most of cases had cardiomegaly , and ↑ broncho- vascular markings i.e. (lung plethora ) , while ECG revealed that the vast majority of cases had incomplete right bundle branch block (IRBBB) , followed by right axis deviation . br Extra-cardiac anomalies (ECAs) , In our study, were encountered among (32.3 %) of cases, of them down syndrome was the commonest, whereas the most common complications recorded were, recurrent chest infections in (36.9%) of cases , followed by failure to thrive in (26.2%) ,and the less frequent were arrhythmia and pericardial effusion (1.5%) each . br Concerning therapeutic modalities at time of the study, we found that (58.5%) of our patients needed specific cardiac medications , however , interventional cardiac catheterization (device closure) was proceeded in (23.1%) of cases those who had ASDII only , while (10.8%) of patients underwent surgical closure predominantly ASDI - sinus venosus types . br Conclusion : br The great majority of infants with ASDII are most often asymptomatic. Frequently,the condition is detected by a murmur on routine physical examination when they are school-aged children. Even a large ASD rarely produces clinically evident heart failure in childhood. In younger children, subtle failure to thrive may be present, in older children, varying degrees of exercise intolerance may be noted . br Recommendations br 1. A national study to provide further knowledge about risk factors ( including familial and environmental factors ) related to the country . with further research we can be a part of national program for prevention and control of ASD . br 2. Paediatric cardiac centers should be available and accessible for population and should receive all children even for routine cardiac examination which may help in early detection of cases with ASD which are always asymptomatic and discovered accidently . br 3. Immediate attention at the primary health care level including condensed training course for G.P. to be aware of the problem and how to suspect and deal with . br 4. Early referral of children with suspicious of ASD to the nearest pediatric cardiac centre for early diagnosis and treatment which needs close collaborative relationship with the different levels providing health care (Primary , Secondary and Tertiary ) . br 5. routine cardiac examination and ECHO for all children with down syndrome who have high susceptibility for congenital heart diseases . br 6. Children with easy fatigability , recurrent chest infections , failure to thrive should be given great attention to exclude ASD . br 7. Heart failure in infancy and childhood should be evaluated cautiously for presence of ASD . br 8. when a heart malformation is detected in a patient, a detailed investigation should be done to detect extra-cardiac malformations or vice versa . br 9. Stress on the importance of genetic counseling for women before becoming pregnant especially if there is positive family history of ASD .