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ATRIAL SEPTAL DEFECT (ASD)
ATRIAL SEPTAL DEFECT
CONTENT
Introduction
Types Of ASD
Pathophysiology
Clinical Features
Investigation
Treatment
OPENING
It is a hole between the Right & Left atrium.
This hole exists in everyone before birth.
But, usually closes shortly after being born.
INTRODUCTION
ASD is an abnormal communication between the atria due to a defect in the interatrial septum
TYPES OF ASD
1. Ostium secundum ASD (COMMON)
2. Ostium primum ASD
3. Sinus venosus ASD
4. Coronary sinus ASD
(very rare)
ASD BLOOD FLOW - Hemodynamics
- Atrial Septal Defect
- Opening in the atrial septum
- Normally, LA pressure is higher than RA
- Blood flow from Lt atrium - Rt atrium
- Mixing of Oxygenated(Lt) & deoxygenated (Rt) blood
- Increases the total amount of blood
- Increases Flow into the lung
- perfusion Increase
- Dilation of RA & RV
- Tricuspid & pulmonary annuli - Dilate
- Increases Flow into the lung
- Pulmonary vessels are dilated
- Pulmonary overload
- Flow related Pulmonary hypertension
- Medial hypertrophy of pulmonary muscularization of the artery
- pulmonary vascular obstructive disease
- Reversal of the shunt
- Eisenmenger syndrome
- Right side pressure increase
- Rt - Lt shunt
- Deoxygenated blood circulates to all parts of the body (cyanosis)
CLINICAL FEATURES
Isolated, small shunt
Asymptomatic
Infants
Features o pulmonary overload
Recurrent Upper Respiratory tract Infection
Failure to thrive
CLINICAL FEATURES
Older children
Mild fatigue
Dyspnea that may worse with age
Rare:
Congestive heart failure
ASD HEART SOUND
Active precordium
S1: loud T1
S2: wide fixed split, P2++
Wide, fixed split of S2
INVESTIGATION
Chest x-ray
ECG
Echocardiography
Cardiac catheterization (occasionally)
MANAGEMENT OF ASD
MEDICAL MANAGEMENT
Asymptomatic
Followed up at yearly interval until surgery is recommended prior to school entry.
Symptomatic,
Anti-congestive therapy(reducing preload) with diuretics may be indicated until closure is accomplished.
NON SURGICAL CLOSURE
Several closure device that can be delivered through cardiac catheters have been shown to be safe & efficacious for secundum ASD closure .
DEVICES:
Amplatzer septal Occluder
Gore helex septal occluder
CardioSEAL Occluder
BioSTAR Device
NON SURGICAL CLOSURE - Indication
Secundum ASD - 5mm or more in diameter
(but less than 32mm).
A significant Lt - Rt shunt with clinical evidence of Rt ventricular volume overload
( Qp/ Qs) of ≥1.5:1
There must be enough rim of septal tissue around the defect for appropriate placement of the device
NON SURGICAL CLOSURE - ADVANTAGE
Complete avoidance of cardiopulmonary bypass
Avoidance of pain and residual thoracostomy scars,
A less than 24 hrs hospital stay and rapid recovery
NON SURGICAL CLOSURE - DISADVANTAGE
Currently, there is no transcatheter devices designed for closure of sinus venosus , primum or coronary sinus ASD.
NON SURGICAL CLOSURE
Post device closure
Aspirin 5mg/kg/day for 6 months
SURGICAL CLOSURE
Closure is recommended before school entry to prevent late complications
Complications
Cerebrovascular accident
Postoperative arrhythmias
#cardiology #asd #atrialseptaldefect #lovemedics #tamilmedico #congenitalheartdefect #cyanotic #heart
Негізгі бет ATRIAL SEPTAL DEFECT (ASD)TAMIL - TYPES , HEMODYNAMICS, HEART SOUND - ASD, INVESTIGATION, MANAGEMENT
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