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Atrial Septal Defect
Atrial Septal Defect
Defect Secundum ASD (80%) 30% of all cases of congenital heart disease In PDA duct fails to close 1month after the ex-
Partial atrioventricular septal defect AVSD/pri- Perimembranous ( adjacent to tricuspid pected date of delivery due to defect in constrictor
mum ASD valve) mechanism of the duct.
Muscular (completely surrounded by muscle) Flow if blood is from the aorta to the pulmonary
According to size:- artery.
Small VSD (smaller than aortic valve in diam- In preterm infant PDA presence is not from congen-
eter up to 3mm) ital disease
Large VSD
Symptoms None Small VSD:
Recurrent chest infections Asymptomatic
Arrhythmias(fourth decade onwards) Large VSD
Heart failure with breathlessness and falter-
ing growth after 1 week old
Recurrent chest infection
Physical signs An ejection systolic murmur at upper left ster- Small VSD Continuous murmur beneath left clavicle/Upper
nal edge, due to increased flow at pulmonary Loud pan-systolic murmur(lower left sternal left sternal edge, continues into diastole (because
valve, from increased flow across pulmonary edge pressure in pulmonary is always lower than
valve) Quiet pulmonary second sound aorta)
Fixed widely split heart sound (due to right ven- Large VSD Pulse pressure increased, collapsing or bounding
tricular stroke volume being equal in both inspi- Soft pan-systolic murmur or no murmur pulse
ration and expiration Apical mid-diastolic murmur (from increased When duct is large there will be increased blood
In partial AVSD: Apical pan systolic murmur flow across the mitral valve after blood has flow with heart failure and pulmonary hyperten-
(from atrioventricular valve regurge) circulated through the lungs) sion
Loud pulmonary second sound P2 (from
raised pulmonary arterial pressure)
Tachypnea, tachycardia, and enlarged liver
from heart failure
Active precordium
Chest radiograph Cardiomegaly In Large VSD Usually normal
Enlarged pulmonary arteries Cardiomegaly Normal or enlarged heart
Increased pulmonary vascular markings Enlarged pulmonary arteries Enlarged pulmonary arteries
Increased vascular markings Increased pulmonary vasculature
Pulmonary edema
ECG Secundum ASD In Large VSD Usually normal
- partial right bundle branch block Biventricular hypertrophy by 2 months of age Left ventricular hypertrophy with large left to
- right axis deviation(due to right ventricular right shunt
enlargement) Right ventricular hypertrophy with pulmonary hy-
Partial AVSD pertension
- A superior QRS axis
- Negative deflection in AVF
Echocardiography Will delineate he anatomy In Large VSD Duct readily identified
Demonstrates anatomy of defect
Hemodynamic effects and high pulmonary pres-
sure (due to high flow)
Management If defect is large enough to cause right ventricular Small VSD At 1 year of age:
dilation. Lesion will close spontaneously but prevention of Closure with a coil or occlusion device, introduced
At 3 years to 5 years (to prevent right heart fail- bacterial endocarditis is important: by maintain- through a cardio catheter Occasionally surgical liga-
ure and arrhythmias) ing good dental hygiene, avoiding body piercings tion is required
Secundum ASD and tattoos
Cardiac catheratization with insertion of occlusion In Large VSD
device Surgery performed at 3 month to 6 months of
Partial AVSD age.
surgical correction To manage heart failure and faltering growth
Prevent permanent lung damage from pul-
monary hypertension