ATRIAL SEPTAL DEFECT

Priyanka Jose

Normally, oxygenoxygenpoor blood returns to the right atrium from the body, travels to the right ventricle, then is pumped into the lungs where it receives oxygen. OxygenOxygen-rich 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. aorta.

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..

An atrial septal defect allows oxygenoxygen-rich blood to pass from the left atrium, through the opening in the septum, and then mix with oxygenoxygenpoor blood in the right atrium. atrium.

GROSS SPECIMENS

Etiology
Congenital malformation of interatrial septum Genetics Associated with -Holt oram syndrome - gene defect in TBX5 -Ellis van Creveld syndrome - mutation in the cardiac transcription factor NKX2

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
It depends on 1) the size and direction of the shunt 2) the compliance of the right and left ventricle and the 3) responsive behavior of the pulmonary vascular bed

HEMODYNAMICS
RT.ATRIUM RECEIVES BLOOD FROM SUP. & INF.VENA CAVA & FROM LT. ATRIUM RT.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 LATE & P2 IS DELAYED RV IS FULLY LOADED,SO FURTHER RISE IN RV VOLUME CANNOT OCCUR WIDELY SPLIT S2

FIXED SPLIT S2

ACCENTUATED S2

Types of ASD
Ostium primum Ostium secundum Sinus venosus Common or single atria Mixed defect

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

ON EXAMINATION
INSPECTION PARASTERNL IMPULSE PALPATION SYSTOLIC THRILL AT 2ND LT SPACE

AUSCULTATION
WIDE FIXED SPLIT S2 ACCENTUATED P2 MID DIASTOLIC MURMUR AT LOW LT INTERSPACE

CXR FINDINGS
CARDIOMEGALY RA ENLARGEMENT RV ENLARGEMENT PROMINENT MAIN PULM ARTERY

ECG CHANGES
RT AXIS DEVIATION RT VENT HYPERTROPHY rsR PATTERN IN V1

ECHO PICTURES

Associated co-morbidites coPulmonary hypertension Right sided heart failure Atrial fibrillation or flutter stroke

COMPLICATION
PULMONARY HYPERTENSION(ABOVE 20 YEARS) DECOMPRESSION SICKNESS PARADOXICAL EMBOLI VIRAL MENINGITIS MIGRANE

COMPLICATIONS
Atrial fibrillation (in adults) Heart failure Stroke

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

SURGICAL REPAIR:DEVICES

Catheter delivering ASD device to the left atrium.

The distal disc is opened in the left atrium.

The proximal disc is opened in the right atrium by pulling the sheath back

The device is released by unscrewing the wire

REPAIR

Complications after ASD closure

Device embolisation and malpositioning Post implantation arrythmia Thrombus formation Cardiac perforation Device erosion Increased levels of troponin I Residual shunt