ATRIAL SEPTAL DEFECT

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ATRIAL SEPTAL DEFECT

• BY DR.ANAND

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• Normally, oxygen-poor (blue) blood returns to the
  right atrium from the body, travels to the right
  ventricle, then is pumped into the lungs where it
  receives oxygen. Oxygen-rich (red) blood returns
  to the left atrium from the lungs, passes into
  the left ventricle, and then is pumped out to the
  body through the aorta.

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• An atrial septal defect allows oxygen-rich (red)
  blood to pass from the left atrium, through the
  opening in the septum, and then mix with
  oxygen-poor (blue) blood in the right atrium.

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DEFINITION

• An atrial septal defect is an opening in the
  atrial septum, or dividing wall between the two
  upper chambers of the heart known as the right
  and left atria..

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GROSS SPECIMENS
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EMBRYOLOGY

• The heart is forming during the first 8 weeks of
  fetal development. It begins as a hollow tube,
  then partitions within the tube develop that
  eventually become the septa (or walls) dividing
  the right side of the heart from the left. Atrial
  septal defects occur when the partitioning
  process does not occur completely, leaving an
  opening in the atrial septum.

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HEMODYNAMICS

• RT.ATRIUM RECEIVES BLOOD FROM SUP. INF.VENA
  CAVA FROM LT. ATRIUM

• RT.ATRIUM ENLARGES

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HEMODYNAMICS

• LARGE VOL OF BLOOD FROM RT.ATRIUM PASSES THRU
  NORMAL TRICUSPID VALVE PULMONARY VALVE

• DELAYED DIASTOLIC MURMUR(LOW LT STERNAL BORDER)
• RT.VENTRICLE ENLARGES
• PULMONARY EJECTION MURMUR

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HEMODYNAMICS

• PULM. VALVE CLOSES LATE P2 IS DELAYED
• RV IS FULLY LOADED,SO FURTHER RISE IN RV VOLUME
  CANNOT OCCUR

• WIDELY SPLIT S2
• FIXED SPLIT S2
• ACCENTUATED S2

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PRESENTATION

• recurrent chest infections
• fatigue
• sweating
• rapid breathing
• shortness of breath
• poor growth

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ON EXAMINATION

• INSPECTION
• PARASTRNL IMPULSE

• PALPATION
• SYSTOLIC THRILL AT 2ND LT SPACE

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AUSCULTATION

• WIDE FIXED SPLIT S2
• ACCENTUATED P2
• ESM AT LT 2nd 3rd INTERSPACES
• DELAYED DIASTOLIC MURMUR AT LOW LT INTERSPACE

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CXR FINDINGS

• MOD. CARDIOMEGALY
• RA ENLARGEMENT
• RV ENLARGEMENT
• PROMINENT MAIN PULM ARTERY
• PLETHORIC LUNG FIELDS

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ECG CHANGES

• RT AXIS DEVIATION
• RT VENT HYPERTROPHY
• rsR PATTERN IN V1

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ECHO PICTURES
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SEVERITY ASSESMENT

• INTENSITY OF THE TWO MURMURS
• THE HEART SIZE

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COMPLICATION

• PULMONARY HYPERTENSION(ABOVE 20 YEARS)
• DISAPPEARANCE OF DIASTOLIC MURMUR
• APPEARANCE OF PULM EJECN CLICK
• LOUD PALPABLE P2
• P2_STILL WIDELY SPLIT

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MANAGEMENT

• MEDICAL
• ANTIBIOTICS FOR CHEST INFECTIONS
• DIGOXIN TO INCREASE WORK OF HEART
• DIURETICS TO REDUCE PRELOAD

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SURGICAL REPAIRDEVICES
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REPAIR
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ROBO REPAIR