Download ATRIAL SEPTAL DEFECT

ATRIAL SEPTAL DEFECT
BY DR.ANAND
• 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. Oxygenrich (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.
• 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 oxygenpoor (blue) blood in
the right atrium.
DEFINITION
• 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
• 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
• RT.ATRIUM RECEIVES • RT.ATRIUM
BLOOD FROM SUP. &
INF.VENA CAVA &
FROM LT. ATRIUM
ENLARGES
HEMODYNAMICS
• LARGE VOL OF
BLOOD FROM
RT.ATRIUM PASSES
THRU NORMAL
TRICUSPID VALVE &
PULMONARY VALVE
• DELAYED DIASTOLIC
•
•
MURMUR(LOW LT
STERNAL BORDER)
RT.VENTRICLE
ENLARGES
PULMONARY
EJECTION MURMUR
HEMODYNAMICS
• PULM. VALVE CLOSES • WIDELY SPLIT S2
•
LATE & P2 IS
DELAYED
RV IS FULLY
LOADED,SO FURTHER
RISE IN RV VOLUME
CANNOT OCCUR
• FIXED SPLIT S2
• ACCENTUATED S2
PRESENTATION
• recurrent chest infections
• fatigue
• sweating
• rapid breathing
• shortness of breath
• poor growth
ON EXAMINATION
• INSPECTION
• PARASTRNL IMPULSE
• PALPATION
• SYSTOLIC THRILL AT
2ND LT SPACE
AUSCULTATION
• WIDE FIXED SPLIT S2
• ACCENTUATED P2
• ESM AT LT 2nd & 3rd INTERSPACES
• DELAYED DIASTOLIC MURMUR AT LOW LT
INTERSPACE
CXR FINDINGS
• MOD.
•
•
•
•
CARDIOMEGALY
RA ENLARGEMENT
RV ENLARGEMENT
PROMINENT MAIN
PULM ARTERY
PLETHORIC LUNG
FIELDS
ECG CHANGES
• RT AXIS DEVIATION
• RT VENT
•
HYPERTROPHY
rsR’ PATTERN IN V1
ECHO PICTURES
SEVERITY ASSESMENT
• INTENSITY OF THE TWO MURMURS
• THE HEART SIZE
COMPLICATION
• PULMONARY HYPERTENSION(ABOVE 20
YEARS)
• DISAPPEARANCE OF DIASTOLIC MURMUR
• APPEARANCE OF PULM EJECN CLICK
• LOUD PALPABLE P2
• P2_STILL WIDELY SPLIT
MANAGEMENT
• MEDICAL
• ANTIBIOTICS FOR CHEST INFECTIONS
• DIGOXIN TO INCREASE WORK OF HEART
• DIURETICS TO REDUCE PRELOAD
SURGICAL REPAIR:DEVICES
REPAIR
ROBO REPAIR