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  2. 2. CONTENTS 1. Introduction 2. Defination 3. Types 4. Epidemiology 5. Pathophysiology 6. Clinical features 7. Investigations 8. Risk Factors 9. Management
  3. 3. Introduction  Septal defects are more common eg of non cyanotic heart disease. Most common congenital heart disease in adults. Basically it is opening in interatrial septum due to deficiency in septal tissue.
  4. 4. Defination  Holes of variable size in the interatrial septum, atrioventricular ,or Interventricular septum enable blood to be shunted between the left and right sides Of the heart
  5. 5. Types  Ostium secumdum  Ostium primum  Sinous venousus type
  6. 6.  Ostium Secumdum - It occurs in central portion of septum.  Ostium Primum -It occurs immediately above AV valves and often associated with CLEFT in anterior valve leaflet .  More common In females.  Sinous Venosus Type-It occurs near orifice of superior vena cava And often associated with anomalous pulmonary venous drainage .
  7. 7. Epidemiology Male : Female = 1:2 Most commonly seen in children
  8. 8. Pathophysiology  In ASD the right atrium not only receives blood from SVC and IVC but also from left atrium and is enlarged in size .  Pulmonary vascular resistance which is low or normal at childhood goes as high up as the patient reaches 3rd or 4th decade giving rise to pulmonary hypertension .
  9. 9.  As hypertension increases the initial left to right shunt reverses to right to left shunt - EISENMENGER SYNDROME.  The patient may develop right heart failure or atrial fibrillation
  10. 10. Clinical Features  Dyspnoea Chest Infection Cardiac Failures Arrhythmias
  11. 11. Visible and palpable Right Ventricle 1st heart sound and split with Tricuspid component Wide fixed splitting of S2 Systolic thrill if loud murmur Ejection Click
  12. 12. Murmurs • Pulmonary ejection systolic murmur – Increased pulmonary flow • Tricuspid murmur – is heard over left sternal edge louder on inspiration • Graham-Steell murmur – of pulmonary regurgitation if pulmonary hypertension
  13. 13. • Late systolic murmur – occurs in Ostium secundum • Murmur of mitral incompetence – in Primum defect  Small peripheral pulse – due to reduced Left Ventricular output.
  14. 14. Investigations Chest X-ray Prominent pulmonary artery can be seen and traced upto diaphragm , end on view of pulmonary artery is seen as white dots. ASD also reveals - mild to moderate cardiomegaly - prominent right atrium and right ventricle
  15. 15. ECG Right axis deviation in 85% of cases Left axis deviation and prolonged PR interval seen in ostium primum Right Atrial enlargement
  16. 16. Mild right ventricular hypertrophy Inverted P waves in Sinous Venosus type Right Bundle Branch Block is seen which is partial or complete
  17. 17. Complete heart block may be revealed in ostium primum type Large ASD may have prolonged PR interval
  18. 18. Echocardiogram Reveals enlarged right ventricles with paradoxical septal motion
  19. 19. Management: I. Medical Prompt treatment of respiratory tract infections. Antiarrhythmic medications for atrial fibrillation and supraventricular tachycardia that includes qunidine , procainamide and flucaniamide. Usual measures for hypertension , coronary disease and heart failure.
  20. 20.  Surgical Usually with a patch of pericardium or a prosthetic material or Percutaneous tanscatheter device is used for closure of the defect.
  21. 21. THANK YOU