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Acyanotic Congenital Heart Disease - ASD (Dr. Gunasekaran)

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Acyanotic Congenital Heart Disease - ASD (Dr. Gunasekaran)

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Acyanotic Congenital Heart Disease - ASD (Dr. Gunasekaran)

  1. 1. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD ACYANOTIC CONGENITAL HEART DISEASE
  2. 2. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD
  3. 3. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Sinus venous defect – near the entry of SVC, IVC Coronory sinus Ostium primum- lower part of septum Down Syn(MVPS) Ostium Secondum – in the upper part of septum (Most common)
  4. 4. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD
  5. 5. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD RATV RVPV  PALungsPVLALVAorta Other parts of the body What organic murmur? Why? What flow murmurs? Why? Which chamber gets enlarged? Position of AI? Type of AI? Why recurrent RTI?
  6. 6. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Size: Defect of what size of ASD , usually cause symptoms in infancy? 2 cm
  7. 7. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Symptoms in ASD Small ASD: Asymptomatic; growth is normal; Murmur & Change in HS - routine clinical examination. Large ASD: Breathlessness on exertion Exercise intolerance Feeding difficulties Failure to thrive Frequent RTI (in all RTIs) Forehead sweating (if failure) Chest pain, palpitation, syncope ???
  8. 8. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Vitals in ASD Pulse: Volume? Rate? Character? Rhythm? Blood pressure?
  9. 9. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Examination of heart Inspection: Precordial bulge (Cardiomegaly – Pliable chest) Harrison sulcus +/- Respiratory distress (LRTI)
  10. 10. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Examination of heart Palpation: Apical position: Shifted out (RV enlarge) Apical impulse type: Normal Palpate in the para-sternal area: Para-sternal lift due to volume overload to RV
  11. 11. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Examination of heart Auscultation: Heart sounds: what is the change in S2 S2 wide & fixed split; do not vary with respiration. Murmurs: what murmur is common? Why it occurs? ESM – Pulmonary area - grade 2 0r 3 (Remember, shunt remains silent) Other possible murmurs: Flow murmurs –MDM at TA Inspn: A2 P2 Expn: A2 P2
  12. 12. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Differential diagnosis of Wide S2 Late Pulmonary Valve closure: Electrical: RBBB (Delayed excitation & hence, delayed emptying of RV) WPW Mechanical: PS: Systolic overload ASD , TAPVC: Diastolic overload RVF: Combined Systolic & Diastolic overload Early Aortic Valve closure: MR
  13. 13. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Complications Frequent LRTI Failure to thrive Congestive Cardiac Failure – Very rare (only in 3rd or 4th decade) Pulmonary Hypertension- Very rare Eisenmenger’s syndrome – Very rare Infective Endocarditis-Unknown in OS type
  14. 14. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Natural History Spontaneous closure : based on size & age < 3 mm: 100% close, by 1 ½ years of age >8 mm / > 2 years: rarely, close
  15. 15. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Investigations Chest X Ray: Cardiomegaly, Increased PBF, Lung Infn. ECG: Chamber enlargement ECHO:
  16. 16. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Management Medical: Diet: High calorie & high protein Anemia correction
  17. 17. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Management - Surgical Closure: Simple suture Patch of Pericardium or Teflon Decision based on Size of defect Age: surgery is usually delayed until 2-4 years of age
  18. 18. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Management - Surgical Contraindications for surgery: severe PHT PVR > 8 wood units/m2 BSA not responding to isoproterenol infusion > 12 wood units / m2 BSA
  19. 19. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD Syndromes associated with ASD 1. Chromosomal anomalies: Trisomies 21 (Down synd) Trisomy 18 (Edward synd) Trisomy 13 (Patau synd) 2. Syndromes: Holt - Oram syndrome (Thumb with extra phalanx & deformities of radius and ulna) TAR syndrome: Thrombocytopenia & Absent Radius 3. Maternal conditions: Phenytoin, Congenital Rubella
  20. 20. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASDOS ASD OP ASD More common Less common Defect is high in the septum Defect is low in septum Not connected with Down Often associated with Down’s No Valve defects MVPS is seen in 8-37% PHT is very rare PHT is possible ECG: RAD (+60-90) (N: +40-60) ECG: LAD (0-30)
  21. 21. Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI. Acyanotic Congenital Heart Disease - ASD

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