ASD• An atrialseptal defect (ASD) is a hole in the wall between the two upper chambers of your heart.• The condition is present from birth (congenital).• Smaller atrialseptal defects may close on their own during infancy or early childhood.• Large and long-standing atrialseptal defects can damage your heart and lungs. An adult who has had an undetected atrialseptal defect for decades may have a shortened life span from heart failure or high blood pressure in the lungs. Intervention is usually necessary to repair atrialseptal defects to prevent complications.
Causes of Atrial Septal Defect (ASD)• Doctors know that heart defects present at birth (congenital) arise from errors early in the heart development, but there is often no clear cause. Genetics and environmental factors may play a role.• An atrialseptal defect allows freshly oxygenated blood to flow from the left upper chamber of the heart (left atrium) into the right upper chamber of the heart (right atrium). There it mixes with deoxygenated blood and is pumped to the lungs, even though it is already refreshed with oxygen.• If the atrialseptal defect is large, this extra blood volume can overfill the lungs and overwork the heart. If not treated, the right side of the heart eventually enlarges and weakens. In some cases, the blood pressure in your lungs increases as well, leading to pulmonary hypertension.
Symptoms of Atrial Septal Defect (ASD)• Many babies born with atrialseptal defects do not have signs or symptoms. In adults, signs or symptoms may not develop until age 30 or later.• Your doctor may first uncover an atrialseptal defect during a regular checkup while listening to your heart using a stethoscope. Hearing a heart murmur may signal a hole in your heart.• Atrialseptal defects are often found when an ultrasound exam of the heart (echocardiogram) is done for another reason.• Signs and symptoms of atrialseptal defects develop once damage occurs to the heart and lungs. Infants with larger atrialseptal defects may have poor appetites and not grow as they should. Adults and infants may have signs of heart failure or arrhythmias.
When to seek medical advice for Atrial Septal Defect (ASD) :Poor appetite Failure to gain weight 2 1 BluishShortness of discoloration of 2 2 breath the skin Easy tiring Swelling of 2 skipped beats 2 legs, feet or abdomen
Morphology MORPHOLOGYTypes of ASD:Ostium primumOstium secundumSinus venosusCoronary sinus defects↑Left to right shunt:* left ventricular compliance↓* left atrial pressure ↑
Percutaneous ASD closure • Percutaneous closure of an ASD is indicated for the closure of secundum ASDs with a sufficient rim of tissue around the septal defect so that the closure device does not impinge upon the SVC, IVC, or the tricuspid or mitral valvs. • The Amplatzer Septal Occluder (ASO) is commonly used to close ASDs. The ASO consists of two self-expandable round discs connected to each other with a 4 mm waist, made up of 0.004– 0.005´´ Nitinol wire mesh filled with Dacron fabric. • Percutaneous closure is the method of choice in most centres.
Morphology MORPHOLOGYFour components of Septum:Membranous, inlet, trabecular, outlet (conal,infundibular) part.Types of VSD :Muscular VSDMembranous VSDDoubly committed subarterial VSD
Pathophysiology PATHPHYSIOLOGY Shunt Qp/Qs P/A systolic pressure ratioRestrictive VSD Small 1~1.4 <0.3Moderately Moderate 1.4~2.2 0.3~0.66restrictive VSDNonrestrictive Large >2.2 >0.66VSDEisenmenger Right to <1 1VSD left
THE FUTURE IMPROVED CONTRAST AGENTS InterventionalReal time 3-D imaging cath Improved Accuracy for Repair of Complex CHD Repair of Complex CHD
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