Atrial Septal Defect

Atrial Septal Defect (ASD) adalah Penyakit jantung bawaan berupa lubang pada septum interatrial yang terjadi karena kegagalan fusi septum inter atrial semasa janin. Termasuk PJB nonsianotik, ± 10-15 % dari seluruh PJB dan merupakan PJB pada dewasa paling banyak . Klasifikasi : a. ASD sekundum. Lubang didaerah Fossa Ovalis b. ASD primum. - Lubang di caudal, didaerah perbatasan dgn ventrikel. - Sering disertai kegagalan pertumbuhan endocard cushion → tdpt cleft pd katup mitral c. Defek sinus venosus - Letak di muara v.cava superior atau inferior. - Sering disertai transposisi sebagian v.pulmonalis dextra (APVD).

The outlook for children after ASD surgery is excellent. Closures are successful in more than 9 out of 10 patients. children spend 3 to 4 days in the hospital before going home. the doctor inserts a catheter (a thin. During the surgery. When treatment of an ASD is required. Your child is placed on a heartlung bypass machine so that the heart can be opened to do the surgery. When the catheter reaches the septum. About half of all ASDs close on their own over time. TEE is a special type of echo that takes pictures of the heart through the esophagus (the passage leading from the mouth to the stomach). and about 20 percent close within the first year of life. Catheter procedures are much easier on patients than surgery because they involve only a needle puncture in the skin where the catheter is inserted. There is no need to replace the closure device as the child grows. Doctors often decide to close an ASD in children who still have medium to large holes by the time they're 2 to 5 years old. a defect is too large for catheter closure and surgery is needed. . This means that recovery is faster and easier. it involves catheter or surgical procedures to close the hole. scheduling followup medical appointments. They will talk about preventing blows to the chest as the incision heals. from ASD surgery are very rare. flexible tube) into a vein in the groin (upper thigh) and threads it to the heart's septum. limiting activity while your child recovers. with no significant leakage. He or she then repairs the defect with a special patch that covers the hole. Within 6 months. Surgery Open-heart surgery generally is done to repair primum or sinus venosus ASDs. The device is secured in place and the catheter is withdrawn from the body. the cardiac surgeon makes an incision (cut) in the chest to reach the ASD. Rarely. and determining when your child can go back to his or her regular activities. the most common type of ASD. the device is pushed out of the catheter and positioned so that it plugs the hole between the atria. Catheter Procedure Doctors can use catheter procedures to close secundum ASDs. The catheter has a tiny umbrella-like device folded up inside it. bathing. Complications. The outlook for children having this procedure is excellent.Treating Atrial Septal Defect Periodic checkups are done to see whether an atrial septal defect (ASD) closes on its own. On average. Doctors often use echocardiography (echo) or transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE) as well as angiography (an-jee-OG-ra-fee) to guide them in threading the catheter to the heart and closing the defect. normal tissue grows in and over the device. During the procedure. such as bleeding and infection.

However. appear very good. the avoidance of cardiopulmonary bypass. Potential drawbacks and concerns include residual shunting around the device.Not all children with an atrial septal defect are candidates for surgery. Such techniques require individuals with considerable expertise in the field of interventional pediatric cardiology and cooperation between the interventionalist and the noninvasive imaging specialists. In general. which occurs in approximately one third of patients. On occasion. Transcatheter approaches to atrial septal defect closure are well accepted in the pediatric population. Shunting less than this in children with small defects and in those with existing pulmonary hypertension may be observed. which is only indicated for those children with clinically significant left-to-right shunting. Long-term safety concerns are noted because device placement in smaller children is still relatively new. These improve cosmetic appearances and decrease hospital stays. Long-term followup studies will provide further information. These techniques are ideally suited for simple closure of a secundum atrial septal defect. symptoms may be nonspecific and include irritability and decreased appetite. the medium. tamponade occurs and requires pericardiocentesis.[15] The surgical mortality rate is low in patients with uncomplicated atrial septal defects. Overall however. a pulmonary-tosystemic flow ratio of 1.[16] . surgery may be performed earlier than this if the child has evidence of CHF.5:1 or more is considered the principal indication for surgical repair. minimally invasive surgical techniques have been developed. the mortality rate should be less than 1%. or general malaise. echocardiographic evidence of right atrial and right ventricular enlargement is usually considered evidence of a clinically significant left-to-right shunt and an indication for surgical closure of the atrial septal defect. either surgically or percutaneously. lack of adequate septal rims to properly seat the device and the need for specific technical expertise and equipment. In an experienced pediatric center. Postoperative morbidity in individuals with atrial septal defects is almost exclusively due to accumulation of pericardial fluid (postpericardiotomy syndrome). fever. and the relatively quick recovery time. embolization during placement requiring surgical intervention. shortness of breath. Surgery is ideally performed in children aged 2-4 years and has a very low mortality rate. In young children. Benefits of the transcatheter approach include its minimal invasiveness. Secundum atrial septal defects are currently the only subtype of atrial septal defect that are amenable to this long-term outcomes of ASD closure. Newer. Because cardiac catheterization is rarely necessary. the lack of median sternotomy. Pericardial effusion should be suspected in any pediatric patient who undergoes postsurgical repair of an atrial septal defect and who presents with chest pain.

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