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

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

DEFINITIONDEFINITION

• An atrial septal An atrial septal defect is an opening defect is an opening in the atrial septum, in the atrial septum, or dividing wall or dividing wall between the two between the two upper chambers of upper chambers of the heart known as the heart known as the right and left the right and left atria.. 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 weeks of fetal development. It begins as a hollow tube, then partitions within as a hollow tube, then partitions within the tube develop that eventually the tube develop that eventually become the septa (or walls) dividing become the septa (or walls) dividing the right side of the heart from the left. the right side of the heart from the left. Atrial septal defects occur when the Atrial septal defects occur when the partitioning process does not occur partitioning process does not occur completely, leaving an opening in the completely, leaving an opening in the atrial septum. atrial septum.

HEMODYNAMICSHEMODYNAMICS

• RT.ATRIUM RT.ATRIUM RECEIVES BLOOD RECEIVES BLOOD FROM SUP. & 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 & PULMONARY VALVEVALVE

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

• RT.VENTRICLE RT.VENTRICLE ENLARGESENLARGES

• PULMONARY PULMONARY EJECTION MURMUREJECTION MURMUR

HEMODYNAMICSHEMODYNAMICS

• PULM. VALVE PULM. VALVE CLOSES LATE & P2 CLOSES LATE & P2 IS DELAYEDIS DELAYED

• RV IS FULLY RV IS FULLY LOADED,SO LOADED,SO FURTHER RISE IN FURTHER RISE IN RV VOLUME 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 PARASTRNL IMPULSEIMPULSE

• PALPATIONPALPATION

• SYSTOLIC THRILL SYSTOLIC THRILL AT 2AT 2NDND 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 DELAYED DIASTOLIC MURMUR AT LOW LT INTERSPACELOW LT 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 PULMONARY HYPERTENSION(ABOVE 20 YEARS)20 YEARS)

• DISAPPEARANCE OF DIASTOLIC DISAPPEARANCE OF DIASTOLIC MURMURMURMUR

• 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 DIGOXIN TO INCREASE WORK OF HEARTHEART

• DIURETICS TO REDUCE PRELOADDIURETICS TO REDUCE PRELOAD

SURGICAL REPAIR:DEVICESSURGICAL REPAIR:DEVICES

REPAIRREPAIR

ROBO REPAIRROBO REPAIR