Acyanotic Congenital Heart Disease - ASD (Dr. Gunasekaran)

Dr. D. Gunasekaran D, MD., Dept., o f Paediatrics, MGMCRI.

Acyanotic Congenital Heart Disease - ASD

ACYANOTIC CONGENITAL HEART DISEASE

Dr. D. Gunsekaran Consultant Paediatrician



Atrial Septal Defect


Acyanotic Congenital Heart Disease - ASD Types of ASD

Sinus venous defect – near the entry of

SVC, IVC Coronory

sinus

Ostium primum- lower part of septum

Down Syn(MVPS)

Ostium Secondum – in the upper part of

septum (Most common)


Acyanotic Congenital Heart Disease - ASD ASD



RATV RVPV PALungsPVLALVAorta

Other parts of the body

What organic murmur? Why?What flow murmurs? Why?Which chamber gets enlarged? Position of AI?

Type of AI?Why recurrent RTI?

Hemodynamic changes



Size: Defect of what size of ASD , usually cause symptoms in infancy?

2 cm



Symptoms in ASDSmall ASD: Asymptomatic; growth is normal; Murmur & Change in HS - routine clinical

examination.Large ASD: Breathlessness on exertionExercise intoleranceFeeding difficultiesFailure to thriveFrequent RTI (in all RTIs)Forehead sweating (if failure)Chest pain, palpitation, syncope ???



Vitals in ASD

Pulse: Volume? Rate? Character? Rhythm?Blood pressure?



Examination of heart

Inspection: Precordial bulge (Cardiomegaly – Pliable chest)

Harrison sulcus +/-

Respiratory distress (LRTI)



Examination of heart

Palpation:

Apical position: Shifted out (RV enlarge) Apical impulse type: Normal Palpate in the para-sternal area: Para-sternal lift due to volume

overload to RV



Examination of heartAuscultation: Heart sounds: what is the change in S2S2 wide & fixed split; do not vary with respiration.

Murmurs: what murmur is common? Why it occurs?ESM – Pulmonary area - grade 2 0r 3 (Remember, shunt remains silent)Other possible murmurs: Flow murmurs –MDM at TA

Inspn: A2 P2

Expn: A2 P2



Differential diagnosis of Wide S2Late Pulmonary Valve closure:Electrical:RBBB (Delayed excitation & hence, delayed emptying of RV)WPWMechanical: PS: Systolic overload ASD , TAPVC: Diastolic overloadRVF: Combined Systolic & Diastolic overloadEarly Aortic Valve closure: MR



Complications

Frequent LRTIFailure to thrive

Congestive Cardiac Failure – Very rare (only in 3rd or 4th decade)

Pulmonary Hypertension- Very rareEisenmenger’s syndrome – Very rare

Infective Endocarditis-Unknown in OS type



Natural History

Spontaneous closure : based on size & age

< 3 mm: 100% close, by 1 ½ years of age

>8 mm / > 2 years: rarely, close



Investigations

Chest X Ray: Cardiomegaly, Increased PBF, Lung Infn.

ECG: Chamber enlargement

ECHO:



ManagementMedical: Diet: High calorie & high protein Anemia correction



Management - Surgical

Closure: Simple suture Patch of Pericardium or Teflon

Decision based on Size of defect Age: surgery is usually delayed until 2-4

years of age



Management - Surgical

Contraindications for surgery: severe PHT

PVR > 8 wood units/m2 BSA not responding to isoproterenol infusion

> 12 wood units / m2 BSA



Syndromes associated with ASD1. Chromosomal anomalies: Trisomies 21 (Down

synd) Trisomy 18

(Edward synd) Trisomy 13 (Patau

synd)

2. Syndromes: Holt - Oram syndrome (Thumb with extra

phalanx & deformities of radius

and ulna) TAR syndrome: Thrombocytopenia & Absent

Radius

3. Maternal conditions: Phenytoin, Congenital Rubella


Acyanotic Congenital Heart Disease - ASD OS ASD OP ASD

More common Less common

Defect is high in the septum

Defect is low in septum

Not connected with Down

Often associated with Down’s

No Valve defects MVPS is seen in 8-37%

PHT is very rare PHT is possible

ECG: RAD (+60-90) (N: +40-60)

ECG: LAD (0-30)



Bye-Bye

Healthcare

Acyanotic Congenital Heart Disease - ASD (Dr. Gunasekaran)