ATRIAL SEPTAL DEFECTATRIAL SEPTAL DEFECT

BY DR.ANANDBY DR.ANAND

• Normally, oxygen-poor Normally, oxygen-poor (blue) blood returns to (blue) blood returns to the right atrium from the the right atrium from the body, travels to the right body, travels to the right ventricle, then is pumped ventricle, then is pumped into the lungs where it into the lungs where it receives oxygen. Oxygen-receives oxygen. Oxygen-rich (red) blood returns to rich (red) blood returns to the left atrium from the the left atrium from the lungs, passes into the left lungs, passes into the left ventricle, and then is ventricle, and then is pumped out to the body pumped out to the body through the aorta.through the aorta.

• An atrial septal defect An atrial septal defect allows oxygen-rich allows oxygen-rich (red) blood to pass (red) blood to pass from the left atrium, from the left atrium, through the opening through the opening in the septum, and in the septum, and then mix with oxygen-then mix with oxygen-poor (blue) blood in poor (blue) blood in the right atrium.the right atrium.

DEFINITIONDEFINITION

• An atrial septal defect An atrial septal defect is an opening in the is an opening in the atrial septum, or atrial septum, or dividing wall between dividing wall between the two upper the two upper chambers of the heart chambers of the heart known as the right known as the right and left atria.. and left atria..

GROSS SPECIMENSGROSS SPECIMENS

EMBRYOLOGYEMBRYOLOGY

• The heart is forming during the first 8 The heart is forming during the first 8 weeks of fetal development. It begins as a weeks of fetal development. It begins as a hollow tube, then partitions within the hollow tube, then partitions within the tube develop that eventually become the tube develop that eventually become the septa (or walls) dividing the right side of septa (or walls) dividing the right side of the heart from the left. Atrial septal the heart from the left. Atrial septal defects occur when the partitioning defects occur when the partitioning process does not occur completely, process does not occur completely, leaving an opening in the atrial septum. leaving an opening in the atrial septum.

HEMODYNAMICSHEMODYNAMICS

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

• RT.ATRIUM RT.ATRIUM ENLARGESENLARGES

HEMODYNAMICSHEMODYNAMICS

• LARGE VOL OF LARGE VOL OF BLOOD FROM BLOOD FROM RT.ATRIUM PASSES RT.ATRIUM PASSES THRU NORMAL THRU NORMAL TRICUSPID VALVE & TRICUSPID VALVE & PULMONARY VALVEPULMONARY VALVE

• DELAYED DIASTOLIC DELAYED DIASTOLIC MURMUR(LOW LT MURMUR(LOW LT STERNAL BORDER) STERNAL BORDER)

• RT.VENTRICLE RT.VENTRICLE ENLARGESENLARGES

• PULMONARY PULMONARY EJECTION MURMUREJECTION MURMUR

HEMODYNAMICSHEMODYNAMICS

• PULM. VALVE CLOSES PULM. VALVE CLOSES LATE & P2 IS LATE & P2 IS DELAYEDDELAYED

• RV IS FULLY RV IS FULLY LOADED,SO FURTHER LOADED,SO FURTHER RISE IN RV VOLUME RISE IN RV VOLUME CANNOT OCCURCANNOT OCCUR

• WIDELY SPLIT S2WIDELY SPLIT S2

• FIXED SPLIT S2FIXED SPLIT S2

• ACCENTUATED S2ACCENTUATED S2

PRESENTATIONPRESENTATION

• recurrent chest infections recurrent chest infections

• fatigue fatigue

• sweating sweating

• rapid breathing rapid breathing

• shortness of breath shortness of breath

• poor growth poor growth

ON EXAMINATIONON EXAMINATION

• INSPECTIONINSPECTION

• PARASTRNL IMPULSEPARASTRNL IMPULSE• PALPATIONPALPATION

• SYSTOLIC THRILL AT SYSTOLIC THRILL AT 22NDND LT SPACE LT SPACE

AUSCULTATIONAUSCULTATION

• WIDE FIXED SPLIT S2WIDE FIXED SPLIT S2

• ACCENTUATED P2ACCENTUATED P2

• ESM AT LT 2ESM AT LT 2ndnd & 3 & 3rdrd INTERSPACES INTERSPACES

• DELAYED DIASTOLIC MURMUR AT LOW DELAYED DIASTOLIC MURMUR AT LOW LT INTERSPACELT INTERSPACE

CXR FINDINGSCXR FINDINGS

• MOD. MOD. CARDIOMEGALYCARDIOMEGALY

• RA ENLARGEMENT RA ENLARGEMENT

• RV ENLARGEMENTRV ENLARGEMENT

• PROMINENT MAIN PROMINENT MAIN PULM ARTERYPULM ARTERY

• PLETHORIC LUNG PLETHORIC LUNG FIELDSFIELDS

ECG CHANGESECG CHANGES

• RT AXIS DEVIATIONRT AXIS DEVIATION

• RT VENT RT VENT HYPERTROPHYHYPERTROPHY

• rsR’ PATTERN IN V1rsR’ PATTERN IN V1

ECHO PICTURESECHO PICTURES

SEVERITY ASSESMENTSEVERITY ASSESMENT

• INTENSITY OF THE TWO MURMURSINTENSITY OF THE TWO MURMURS

• THE HEART SIZETHE HEART SIZE

COMPLICATIONCOMPLICATION

• PULMONARY HYPERTENSION(ABOVE 20 PULMONARY HYPERTENSION(ABOVE 20 YEARS)YEARS)

• DISAPPEARANCE OF DIASTOLIC MURMURDISAPPEARANCE OF DIASTOLIC MURMUR

• APPEARANCE OF PULM EJECN CLICKAPPEARANCE OF PULM EJECN CLICK

• LOUD PALPABLE P2LOUD PALPABLE P2

• P2_STILL WIDELY SPLITP2_STILL WIDELY SPLIT

MANAGEMENTMANAGEMENT

• MEDICALMEDICAL

• ANTIBIOTICS FOR CHEST INFECTIONS ANTIBIOTICS FOR CHEST INFECTIONS

• DIGOXIN TO INCREASE WORK OF HEARTDIGOXIN TO INCREASE WORK OF HEART

• DIURETICS TO REDUCE PRELOADDIURETICS TO REDUCE PRELOAD

SURGICAL REPAIR:DEVICESSURGICAL REPAIR:DEVICES

REPAIRREPAIR

ROBO REPAIRROBO REPAIR