Atrial Septal Defect: Definition
A communication between the atria across a defect in the interatrial septum.ASD: Types
- Secundum ASD- Primum ASD
- Sinus venosus defect
- Inferior vena caval defect
- Common atrium
ASD: Associated lesions
Pulmonary stenosis 10%Partial anomalous pulmonary venous connection 7%
VSD 5%
PDA 3%
Mitral stenosis 2%
ASD: Pathophysiology
Left to right shuntPulmonary blood flow increases
Volume over load of right ventricle and pulmonary vascular bed results
May be well tolerated for long periods
Pulmonary vascular resistance progressively rises
Pulmonary hypertension and shunt reversal may ultimately result without treatment.
ASD: Clinical features( symptoms)
- Symptoms depend on the shunt fraction- Most are usually asymptomatic in the first 2 decades
- Cardiac murmur on routine physical examination
- Dyspnoea
- Easy fatigability with limited exercise tolerance especially when shunt fraction is large.
ASD: Clinical features( signs)
Prominent right ventricular impulse LSESystolic ejection murmur LSE due to increased flow across pulmonary vein
Fixed splitting of S2
ASD: Diagnosis
ECGCXR
ECHO
ASD: Treatment
Surgical closure under CPB
Direct suturing
Pericardial patch
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