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Overview
Three types
Primum ASD
Secundum ASD
Sinus venosus
AVSD Atrio ventricular septal
defect
Primum
Sinus Venosus
ASD- Anatomy/Prevalence
Secundum 75%
Primum 15%
Sinus Venosus 10%
Cor Sinus (rare)
Physiologic Consequences
Shunt Flow
Size of defect
Relative compliance of ventricles
Relative resistance of pulmonary/systemic circulation
Clinical Symptoms
Physical Signs
S2 wide/fixed splitting
RV/PA palpable impulse (if lg defect)
systolic ejection murmur 2nd L ICS
mid-diastolic TV rumble
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Auscultation in ASD
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ECG
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ECHO
Subcostal
view of
Intraatrial
Septum
Color
Flow/
Contrast
Good for
secundum
, primum
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Treatment
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Treatment
Surgical Closure
Good prognosis:
closure age < 25, PA pressure <40
If >25 or PA>40, decreased survival due to
CHF, stroke, and afib
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Three types
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May be anywhere in
intra-ventricular septumclinical course depends
on the shunt size and
involvement of
pulmonary vascular bed.
Approx of all VSDs are
small, and more than
close spontaneously.
Highest closure rates in the
first decade of life.
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PATHOPHYSIOLOGY
CLINICAL FEATURES
PHYSICAL FINDINGS
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INVESTIGATIONS
CHEST RADIOGRAPHY
- normal
- biventricular hypertrophy
- pulmonary plethora
ELECTROCARDIOGRAPHY
-smallVSD ~ normal tracing
-mod.VSD ~ broad,notched P wave characteristic of Lt. Atrial
overload as well as LV overload,namely,deep Q waves & tall
R waves in leads V5 and V6 and often AF
-large VSD ~RVH with rt. axis deviation. With further
progression biventricular hypertrophy;P waves may be
notched/peaked.
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INVESTIGATIONS .
ECHOCARDIOGRAPHY
two-dimensional &doppler colour flow
ANGIOGRAPHY
(cardiac catheterization and angiography)
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COMPLICATIONS
INTERVENTION
3 MAJOR TYPES
SMALL (less than 3mm
diameter)
- hemodynamically
insignificant
- b/w 80-85% of all VSDs
- all close spontaneously
* 50% by 2yrs
* 90% by 6yrs
* 10% during school yrs
MODERATE VSDs
* 3-5mm diameter
* least common group of children(3-5%)
* w/o evidence of ccf/ pulm.htn can be
followed until spontaneous closure
occurs.
LARGE VSDs WITH NORMAL PVR
* 6-10mm in diameter
* usually requires surgery Conservative
treatment
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DEFINITION
Patent ductus arteriosus
(PDA) is a heart problem
that is usually noted in
the first few weeks or
months after birth. It is
characterized by a
connection between the
aorta and the pulmonary
artery, which allows
oxygen-rich (red) blood
that should go to the
body to re-circulate
through the lungs
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IN DEPTH
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IN GROSS
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HEMODYNAMICS
LT TO RT SHUNT
OCCURS BOTH
DURING SYSTOLE
& DIASTOLE
LARGE AMT OF
BLOOD PASSES
THRU PULM ART-LT
ATRIUM MITRAL
VALVE
CONTINOUS
MURMUR
ACCENTUATED S1
MITRAL DELAYED
DIASTOLIC
MURMUR
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HEMODYNAMICS
LATE A2
PARADOXICALLY
SPLIT S2
AORTIC EJECTION
CLICK
AORTIC EJECTION
SYSTOLIC
MURMUR
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PRESENTATION
ON EXAMINATION
INSPECTION
CAROTID
PULSATIONS
HYPERKINETIC & LT
VENTRICULAR TYPE
OF APICAL IMPULSE
PALPATION
SYSTOLIC OR
CONTINOUS THRILL
AT 2ND LT
INTERSPACE
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AUSCULTATION
ACCENTUATED S1
NARROWLY OR PARADOXICALLY SPLIT
S2
LOUD P2
CONTINOUS/GIBSONS/TRAIN-INTUNNEL MURMUR BEST HEARD IN
INFRACLAVICULAR REGION
MITRAL DELAYED DIASTOLIC MURMUR
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CXR FINDINGS
CARDIOMEGALY
LA ENLARGEMENT
LV ENLARGEMENT
PROMINENT
AORTIC KNUCKLE
PULM PLETHORA
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ECG CHANGES
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ECHO PICTURES
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MANAGEMENT
MEDICAL
INDOMETHACIN 0.1
mg/kg/dose,orally,bd for three doses
Digoxin for increasing working capacity
of heart
Diuretics to reduce preload on heart
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Narrowing in
proximal descending
aorta
May be long/tubular
but most commonly
discrete ridge
Natural hx: poor
prognosis if
unrepaired
Aortic
Aneurysm/dissection
CHF
Premature CADz
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CLINICAL
Rib notching
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Treatment
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Tetralogy of Fallot
4 features
Malalignment VSD
Overriding Aorta
Pulmonic Stenosis
RVH
Variability correlates
with degree of RVOT
obstruction and
size/anatomy of PA
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Blalock-Taussig
Waterston (RPA)
Potts (LPA)
Complete Repair
Ebsteins Anomaly
www.ucch.org
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Massive cardiomegaly,
mainly due to RAE
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Pediatric
murmur
atrial arrhythmias
murmur
cyanosis
exercise intolerance
Eisenmengers Syndrome
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Eisenmenger Complications
Coagulopathy/platelet consumption
Brain abcesses
Cerebral microemboli
Airway hemorrhage
especially moving from lowerhigher
altitudes (air travel, mountains)
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Eisenmenger: Treatment
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