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ATRIAL SEPTAL DEFECT
โ€ข Normally, oxygen-poor
(blue) blood returns to the
right atrium from the body,
travels to the right ventricle,
then is pumped into the
lungs where it receives
oxygen. Oxygen-rich (red)
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.
โ€ข An atrial septal defect
allows oxygen-rich (red)
blood to pass from the
left atrium, through the
opening in the septum,
and then mix with
oxygen-poor (blue)
blood in the right
atrium.
DEFINITION
โ€ข 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..
GROSS SPECIMENS
EMBRYOLOGY
โ€ข 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
โ€ข RT.ATRIUM RECEIVES
BLOOD FROM SUP. &
INF.VENA CAVA & FROM
LT. ATRIUM
โ€ข RT.ATRIUM ENLARGES
HEMODYNAMICS
โ€ข LARGE VOL OF BLOOD
FROM RT.ATRIUM
PASSES THRU NORMAL
TRICUSPID VALVE &
PULMONARY VALVE
โ€ข DELAYED DIASTOLIC
MURMUR(LOW LT
STERNAL BORDER)
โ€ข RT.VENTRICLE
ENLARGES
โ€ข PULMONARY EJECTION
MURMUR
HEMODYNAMICS
โ€ข PULM. VALVE CLOSES
LATE & P2 IS DELAYED
โ€ข RV IS FULLY LOADED,SO
FURTHER RISE IN RV
VOLUME CANNOT
OCCUR
โ€ข WIDELY SPLIT S2
โ€ข FIXED SPLIT S2
โ€ข ACCENTUATED S2
PRESENTATION
โ€ข recurrent chest infections
โ€ข fatigue
โ€ข sweating
โ€ข rapid breathing
โ€ข shortness of breath
โ€ข poor growth
ON EXAMINATION
โ€ข INSPECTION
โ€ข PARASTRNL IMPULSE
โ€ข PALPATION
โ€ข SYSTOLIC THRILL AT 2ND
LT SPACE
AUSCULTATION
โ€ข WIDE FIXED SPLIT S2
โ€ข ACCENTUATED P2
โ€ข ESM AT LT 2nd & 3rd INTERSPACES
โ€ข DELAYED DIASTOLIC MURMUR AT LOW LT
INTERSPACE
CXR FINDINGS
โ€ข MOD. CARDIOMEGALY
โ€ข RA ENLARGEMENT
โ€ข RV ENLARGEMENT
โ€ข PROMINENT MAIN
PULM ARTERY
โ€ข PLETHORIC LUNG
FIELDS
ECG CHANGES
โ€ข RT AXIS DEVIATION
โ€ข RT VENT HYPERTROPHY
โ€ข rsRโ€™ PATTERN IN V1
ECHO PICTURES
SEVERITY ASSESMENT
โ€ข INTENSITY OF THE TWO MURMURS
โ€ข THE HEART SIZE
COMPLICATION
โ€ข PULMONARY HYPERTENSION(ABOVE 20
YEARS)
โ€ข DISAPPEARANCE OF DIASTOLIC MURMUR
โ€ข APPEARANCE OF PULM EJECN CLICK
โ€ข LOUD PALPABLE P2
โ€ข P2_STILL WIDELY SPLIT
MANAGEMENT
โ€ข MEDICAL
โ€ข ANTIBIOTICS FOR CHEST INFECTIONS
โ€ข DIGOXIN TO INCREASE WORK OF HEART
โ€ข DIURETICS TO REDUCE PRELOAD
SURGICAL REPAIR:DEVICES
REPAIR
ROBO REPAIR
THANK YOU

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ATRIAL SEPTAL DEFECT (ASD)