Atrial Septal

Defect
Arvin Raj
061303507
Group B2

 ASD is an acyanotic CHD characterized by

defect in the interatrial septum
Causing a left to right flow between the
atria
Severity
depends on :
- size of defect
- size of shunt
- associated anomalies
Resulting in spectrum from :
- asymptomatic to
- right sided overload, pulm. Art. HTN, and
even
atrial arrhythmias

 ASD represents 10% of all CHD

( emed )
3 common types
- Ostium

secundum ( 75% )

- Ostium

Primum ( 15 20% )

- Sinus venosus ( 5 10% )

 Male : female = 1:2

Most infant and children are

asymptomatic, but this again depends

on severity of defect
Symptoms are more prevalent as

patient ages, usually around age of 40

 Magnitude of L R shunt depends on :

- Defect size
- Compliance of ventricles
- Relative resistance in both
pulmonary and
systemic circulation
Shunting occurs during late vent
systole and early diastole

 The volume overload is usually well

tolerated in children
Even though the pulmonary flow may
be more than twice
However if left untreated reversal
of shunt can eventually occur at a
later age.

Presentation
Symptoms
Often asymptomatic
Easy fatigability
Recurrent chest infection
Exertional dyspnoea
Palpitations related to arryhthmias

Signs
Wide fixed split of S2 ( mostly seen in large
defects )

S1 may be split with the second component being

increased in intensity due to delayed tricuspid
closure and forceful contraction of right ventricle

ESM - increase right sided flow ( 2 nd IC space at

upper left sternal border )
Large defects may have rumbling MDM at lower
left sternal border ( increase flow across tricuspid)

CXR

Enlarged
pulmonary
arteries and
increased
vascular
markings

Enlarged
right
atrium
along with
dilatation
of right
ventricle

ECG

Enlarged
p wave
indicating
Right atrial
hypertroph
y

Also note that the

aVF is predominantly
rSR seen and tall R
upwards as
wave
compared to Lead I
Indicating RBBB and
indicating Right Axis
RVH
Deviation
LAD with rSR in V1 is
suggestive of Ostium primum
defect

Echocardiography
Main diagnostic investigation
Transthoracic 2D echocardiography especially
subcostal view is very helpful
Transesophageal Echo used for sinus venosus
defect
Doppler echo is used to demonstrate the flow
across the septum

MRI
Can be use to identify size and location of
defect
A major advantage of MRI is the ability to
quantify right ventricular size, volume, and
function along with the ability to identify
the systemic and pulmonary venous
return.

Treatment
No medical treatment
Surgical
- Median sternotomy with direct closure of
small to moderate defect
- Larger defects closed with autologous
pericardium or syntethic patches like
polyester polymer
( Dacron )or polytetrafluoroethylene ( PTFE )

 Minimally invasive techniques with

hemisternotomy and limited thoracotomy
is to improve cosmetic outcome

Percutaneous Transcatheter Closure

- via femoral vein
- success is as good as 96% in good hands