You are on page 1of 1

etiology

Left atrial pressure exceeds right atrial pressure, leading to increased flow of oxygenated blood from the left atrium into the right atrium. Despite the low pressure difference, a high rate of flow can still occur because of low pulmonary vascular resistance and greater distensibility of the right atrium, which further reduces flow resistance. This volume is well tolerated by the right ventricle because it is delivered under much lower pressure than in a ventricular septal defect. Although there is right atrial and ventricular enlargement, cardiac failure is unusual in an uncomplicated ASD. Pulmonary vascular changes usually occur only after several decades if the defect is unrepaired. .

ASD atrial septal defect

Abnormal opening between the atria, allowing blood flow from the left (higher-pressure) into the right (lower-pressure) atrium.

treatment
• Surgical dacron patch closure of moderate to large defects (also ventricular septal defects) • Open repair with cardiopulmonary bypass (usually before school age) • The sinus venosus defect requires patch placement, so the anomalous right pulmonary venous reuturn is directed to the left atrium with a baffle. • ASD 1 may require repair or, rarely, replacement of mitral valve. • ASD 2 may be closed during cardiac catheterization.

diagnosed by
• ECG • CXR • Confirmed by ECHO

Clinical manifestations
opening between atria
tricuspid valve mitral valve aortic valve

types
Ostium Primum(ASD 1) Opening at low end of septum; (may be with mitral valve abnormalities). Ostium Sedundum (ASD 2) Opening near center of septum. Sinus Venosus Defect Opening near junction of superior vena cava and right atrium; (may be associated with partial anomalous pulmonary venous connection)

• May be asymptomatic • May develop CHF • Characteristic murmur • Risk for atrial dysrhythmias (from atrial enlargement and stretching of conduction fibers) • Risk for pulmonary vascular obstructive disease and emboli formation

prognosis
Very low <1% operative mortality

pulmonary valve

(later in life from chronic increase pulmonary blood flow)

etiology
Higher pressure in the left ventricle and greater systemic arterial circulation vs pulmonary circulation causes blood flow through the defect into the pulmonary artery. Increased blood volume is pumped into the lungs increasing pulmonary vascular resistance. Left-to-right shunting and pulmonary resistance leads to hypertrophy. If the right ventricle is unable to accommodate the increased workload, the right atrium may also enlarge as it attempts to overcome the resistance offered by incomplete right ventricular emptying.

VSD ventricular septal defect
Abnormal opening between ventricles, allowing blood flow from the left (higher-pressure) to the right (lower-pressure). Classified by location: Membranous (80%) or Muscular. Size varies from a pinhole to complete absence of the septum (a common ventricle).
mitral valve aortic valve pulmonary valve tricuspid valve

treatment
• Complete repair in infancy is the preferred approach. Small defects are repaired with a purse string approach. Large defects usually require a knitted Dacron patch sewn over the opening. Both procedures are performed via cardiopulmonary bypass. The repair is generally approached through the right atrium and the tricuspid valve. Postoperative complications include residual VSD and conduction disturbances. • Pulmonary banding used w/ symptomatic infants that can’t take Lasix or digoxin (less common).

diagnosed by
• ECG • CXR • Confirmed by ECHO

prognosis
• Single membranous defects have low mortality (<5%); Multiple muscular defects can have a risk of >20%. • Most close on own by 6 months. • Most children respond to surgery and catch up on growth

Clinical manifestations
• Dyspnea • Tachypnea • CHF • Characteristic murmur (combined with systolic thrill) • Pulmonary infection (bacterial endocarditis, pulmonary vascular obstructive disease)

opening between ventricles

• Eisenmenger syndrome risk (left-to-right shunt in the heart)

etiology
The hemodynamic consequences of PDA depend on the size of the ductus. Pulmonary and systemic circulation are almost identical, thus equalizing the resistance in the aorta and pulmonary artery. As the systemic pressure exceeds the pulmonary pressure, blood begins to shunt the aorta, across the duct, to the pulmonary artery (left-to-right shunt). The additional blood is recirculated through the lungs and returned to the left atrium and left ventricle. The effect of this altered circulation is increased workload on the left side of the heart, increased pulmonary vascular congestion and resistance, and increased right ventricular pressure and hypertrophy.

PDA patent ductus arteriosis
vessel connecting aorta and pulmonary artery

Failure of the fetal ductus arteriosus (connecting the aorta and pulmonary artery) to close in first weeks of life, allowing blood to flow from the aorta (higher pressure) to the pulmonary artery (lower pressure), causing a left-to-right shunt.

treatment
• Administration of indomethacin (prostaglandin inhibitor) has proved successful in closing a patent ductus in premies and newborns. • Surgical division or ligation of the

diagnosed by
• ECG • CXR • Confirmed by ECHO

Clinical manifestations
• Patients may be asymptomatic or show signs of CHF • Characteristic machine-like murmur • Widened pulse pressure and bounding pulses (runoff of blood from aorta to the pulmonary artery) • Risk for bacterial endocarditis and pulmonary vascular obstructive disease (from chronic excessive pulmonary blood flow)

A heart murmur is often the only clue that a child has a PDA.
• Poor feeding habits • Shortness of breath • Sweating while feeding • Tiring very easily • Poor growth

prognosis
Both procedures can be done at low risk with less than 1% mortality.

patent vessel via a left thoracotomy. A newer technique, visual assisted thoracoscopic surgery (VATS), uses a thoracoscope and instruments placed through three small incisions on the left side of the chest and eliminates the need for a thoracotomy, thereby speeding postoperative recovery.