Atrial septal defects

sinus venosus
ostium secundum
ostium primum
coronary sinus

Atrial septal defects

Atrial Septal Defects

8% of CHD
M :F = 3:1
L-> R shunt at atrial level
Increased pulmonary blood flow
Shunt due to greater compliance of RV
Volume overload of RA and RV

ASD secundum
clinical
Often asymptomatic in early years
Usually detected on examination at school
entry
Majority well nourished with good exercise
tolerance
Cardiac failure and pulmonary
hypertension may develop with large ASD

ASD secundum
clinical

RV type apical impulse

Wide fixed split S2
Gr 1-3/6 ESM maximum in 2nd LICS
MDM at LSE to apex in large ASDs

ASD secundum
Investigations
Hb normal
ECG RVH rsR in V1 and V4R
Cxray may be normal in small ASD,may
show pulmonary plethora and large PA in
moderate or large defect
2Decho displays ASD and flow across it
Catheter rarely required

ASD secundum
outcome/treatment
Majority have no symptoms until 20
30+yrs when
Pulmonary HTN, CCF, AF develop
Low risk for infective endocarditis
Spontaneous closure in about 40%
Treatment Surgery at 3-5yrs.
Transcatheter closure in some centres.

ASD
Ostium primum

Atrioventricular septal defect

Ostium primum
Associated with MI, TI, VSD
Increased incidence of PHT, CCF,
Eisenmengers syn in AVCD
High incidence in Trisomy 21
Typical ECG in AV defects LAD + RVH or
BiVH
Complete AVSD defects may need
surgery by 1 yr