short and simple

1. Atrial Septal Defect
Arvin Raj
061303507
Group B2

2. • ASD isan acyanotic CHD characterized by defect
in theinteratrial septum
• Causing aleft to right flow between theatria
• Severity dependson :
- sizeof defect
- sizeof shunt
- associated anomalies
• Resulting in spectrum from :
- asymptomatic to
- right sided overload, pulm. Art. HTN, and even
atrial arrhythmias

3. • ASD represents10% of all CHD ( emed )
• 3 common types
- Ostium secundum ( 75% )
- Ostium Primum ( 15 – 20% )
- Sinusvenosus( 5 – 10% )

5. • Male: female= 1:2
• Most infant and children areasymptomatic,
but thisagain dependson severity of defect
• Symptomsaremoreprevalent aspatient ages,
usually around ageof 40

6. • Magnitudeof L – R shunt dependson :
- Defect size
- Complianceof ventricles
- Relativeresistancein both pulmonary and
systemic circulation
• Shunting occursduring latevent systoleand
early diastole

7. • Thevolumeoverload isusually well tolerated
in children
• Even though thepulmonary flow may bemore
than twice
• However if left untreated… reversal of shunt
can eventually occur at alater age.

8. Presentation
Symptoms
• Often asymptomatic
• Easy fatigability
• Recurrent chest infection
• Exertional dyspnoea
• Palpitationsrelated to arryhthmias

9. Signs
• Widefixed split of S2 ( mostly seen in largedefects)
• S1 may besplit with thesecond component being
increased in intensity dueto delayed tricuspid closureand
forceful contraction of right ventricle
• ESM - increaseright sided flow ( 2nd
IC spaceat upper left
sternal border )
• Largedefectsmay haverumbling MDM at lower left
sternal border ( increaseflow acrosstricuspid)

10. CXR
Enlarged
pulmonary
arteriesand
increased
vascular
markings
Enlarged right
atrium along
with dilatation
of right
ventricle

11. ECG
Enlarged ‘p’
wave
indicating
Right atrial
hypertrophy
rSR’ seen and tall R wave
Indicating RBBB and
RVH
Also notethat theaVF is
predominantly upwardsas
compared to Lead I
indicating Right Axis
Deviation
LAD with rSR’ in V1 issuggestive
of Ostium primum defect

12. Echocardiography
• Main diagnostic investigation
• Transthoracic 2D echocardiography especially subcostal view
isvery helpful
• Transesophageal Echo used for sinusvenosusdefect
• Doppler echo isused to demonstratetheflow acrossthe
septum

13. MRI
• Can beuseto identify sizeand location of defect
• A major advantageof MRI istheability to quantify
right ventricular size, volume, and function along
with theability to identify thesystemic and
pulmonary venousreturn.

14. Treatment
• No medical treatment
• Surgical
- Median sternotomy with direct closureof small to
moderatedefect
- Larger defectsclosed with autologouspericardium or
syntethic patcheslikepolyester polymer
( Dacron )or polytetrafluoroethylene( PTFE )

15. • Minimally invasivetechniqueswith hemisternotomy
and limited thoracotomy isto improvecosmetic
outcome
• PercutaneousTranscatheter Closure
- viafemoral vein
- successisasgood as96% in good hands