ATRIAL SEPTAL DEFECT

BY DR.ANAND

 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. Oxygenrich (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.

 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.

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..

GROSS SPECIMENS

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.

HEMODYNAMICS
RT.ATRIUM RECEIVES RT.ATRIUM
BLOOD FROM SUP. &
INF.VENA CAVA &
FROM LT. ATRIUM

ENLARGES

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

HEMODYNAMICS
PULM. VALVE CLOSES WIDELY SPLIT S2

LATE & P2 IS
DELAYED
RV IS FULLY
LOADED,SO FURTHER
RISE IN RV VOLUME
CANNOT OCCUR

FIXED SPLIT S2
ACCENTUATED S2

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

ON EXAMINATION
INSPECTION
PARASTRNL IMPULSE

PALPATION
SYSTOLIC THRILL AT
2ND LT SPACE

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

CXR FINDINGS
MOD.

CARDIOMEGALY
RA ENLARGEMENT
RV ENLARGEMENT
PROMINENT MAIN
PULM ARTERY
PLETHORIC LUNG
FIELDS

ECG CHANGES
RT AXIS DEVIATION
RT VENT

HYPERTROPHY
rsR PATTERN IN V1

ECHO PICTURES

SEVERITY ASSESMENT
INTENSITY OF THE TWO MURMURS
THE HEART SIZE

COMPLICATION
PULMONARY HYPERTENSION(ABOVE 20

YEARS)
DISAPPEARANCE OF DIASTOLIC MURMUR
APPEARANCE OF PULM EJECN CLICK
LOUD PALPABLE P2
P2_STILL WIDELY SPLIT

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

SURGICAL REPAIR:DEVICES

REPAIR

ROBO REPAIR