Non Surgical intervention in ASD and VSD

ASDASD

Atrial Septal Defect (ASD)

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

Shortness of breath

Bluish discoloration of

the skin

Easy tiring Swelling of legs, feet or abdomen

skipped beats

1

2

2

2

2

2

MorphologyTypes of ASD:

Ostium primum

Ostium secundum

Sinus venosus

Coronary sinus defects

↑Left to right shunt:

* left ventricular compliance↓

* left atrial pressure ↑

MORPHOLOGY

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.

VSDVSD

Morphology

Four components of Septum:

Membranous, inlet, trabecular, outlet (conal,infundibular) part.

Types of VSD :

Muscular VSD

Membranous VSD

Doubly committed subarterial VSD

MORPHOLOGY

Pathophysiology

Shunt Qp/Qs P/A systolic pressure ratio

Restrictive VSD Small 1~1.4 <0.3

Moderately restrictive VSD

Moderate 1.4~2.2 0.3~0.66

Nonrestrictive VSD

Large >2.2 >0.66

Eisenmenger VSD

Right to left

<1 1

PATHPHYSIOLOGY

Coarc Stent Repair

THE FUTURE

Improved Accuracy forRepair of Complex CHD

Real time 3-D imagingInterventional cath

IMPROVED CONTRAST AGENTS

Repair of Complex CHD

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