ATRIAL SEPTAL DEFECT ASD - CF , ETIOLOGY ,PATHO -PHYSIOLOGY, SIGNS & SYM , MANAGEMENT.....ETC

1. ATRIAL SEPTAL
DEFECT
AKSHAY AGRAWAL

2. CONTENTS
1. Introduction
2. Defination
3. Types
4. Epidemiology
5. Pathophysiology
6. Clinical features
7. Investigations
8. Risk Factors
9. Management

5. 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.

6. 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

8. Types
 Ostium secumdum
 Ostium primum
 Sinous venousus type

9.  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 .

12. Epidemiology
Male : Female = 1:2
Most commonly seen in children

13. 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 .

14.  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

16. Clinical Features
 Dyspnoea
Chest Infection
Cardiac Failures
Arrhythmias

17. 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

18. 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

19. • Late systolic murmur – occurs in Ostium
secundum
• Murmur of mitral incompetence – in Primum
defect
 Small peripheral pulse – due to reduced Left
Ventricular output.

20. 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

23. ECG
Right axis deviation in 85% of cases
Left axis deviation and prolonged PR interval seen in
ostium primum
Right Atrial enlargement

24. Mild right ventricular hypertrophy
Inverted P waves in Sinous Venosus type
Right Bundle Branch Block is seen which is partial
or complete

25. Complete heart block may be
revealed in ostium primum type
Large ASD may have prolonged PR
interval

27. Echocardiogram
Reveals enlarged right ventricles with
paradoxical septal motion

29. 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.

30.  Surgical
Usually with a patch of pericardium or a
prosthetic material or Percutaneous tanscatheter
device is used for closure of the defect.

31. THANK YOU