Clinical importance of heart disease screening in school for detecting atrial septal defects with significant shunt.

Abstract

In Japan, some first-, seventh-, and tenth-grade students with atrial septal defects (ASDs) are diagnosed through heart disease screening in schools (HDSS) using electrocardiography (ECG). This study evaluated the clinical relevance of HDSS in diagnosing ASD in patients requiring treatment. The study included patients aged 6-40 years who underwent transcatheter ASD closure (TC-ASD) between February 2014 and December 2019. Data on diagnostic opportunities, age at diagnosis, TC-ASD procedure, body size, defect size, physical examination findings, echocardiography, ECG, and cardiac catheterization were collected from medical records. Among 270 patients, 173 met the inclusion criteria. The diagnostic opportunities were HDSS (51%), incidental detection (23%), and infant-toddler health check-ups (19%). In the HDSS group, 83% were referred for secondary screening due to abnormal ECG findings, primarily incomplete right bundle branch block, and 15% had cardiac murmurs. Notably, 17% of the entire cohort was referred solely due to electrocardiographic abnormalities without significant murmurs. These findings underscore the value of HDSS as a school-based screening system for early detection of ASD. Universal ECG screening plays a crucial role in identifying asymptomatic patients with significant defects, and repeated screening across multiple school grades further increases the likelihood of detecting clinically important ASDs that may otherwise be missed at an early stage. This study supports the importance of continued implementation of structured pediatric screening programs in schools.