ATRIAL SEPTAL DEFECT

TEACHER : PT AVANI BHATT VALIDATED BY : PT BHOOMIKA PRAJAPATI APPROVED BY : PT POONGRUNDAN P.

INTRODUCTION

It is not uncommon congenital abnormality of heart. It constitute about 6 % of all congenital cardiac abnormalities.

 An atrial septal defect is an opening in the

atrial septum. An atrial septal defect allows oxygenated blood to pass from the left atrium, through the opening in the septum, and then mix with deoxygenated blood in the right atrium.

 Due to ASD, right side of heart and lung become overfilled, whereas the left side of heart receives less blood.

Normally foramen ovale exist in the fetal

heart. It allows blood to detour away from the

lungs before birth.

 After birth, the opening is no longer needed and usually closes or becomes very small within several weeks or months.

Sometimes this opening is larger than normal

and doesnt close after birth. As many as 1 in

5 healthy adults still have a small leftover

opening in the wall between the atria, called a Patent Foramen Ovale (PFO).

TYPES OF ASD
The defects are named according to their

location
I. SECUNDUM DEFECT :

Commonest variety.
The defect lies in the center of septum.

Embryologically, it results from failure of

fusion of septum secondum to septum

primum to obliterate foramen ovale.

 Symptoms

Fatigue
Sweating

poor growth
Palpitation

Exertional dyspnoea

Treatment :
Incision : median sternotomy or anterior right thoracotomy through 4th intercostals space. It is closed by direct continues suture with prolene if it is small in size. If it is not possible, prosthetic patch of Dacron or pericardium may be inserted. It is performed with the help of heart- lung machine.

II. OSTIUM PRIMUM DEFECT :

It is uncommon & constitute about 4 -5 % of

patients with ASD.

Defect is usually low down in septum &

associated with incomplete formation of mitral and tricuspid valve.

It is due to defective formation of interatrial septum as it fuses to endocardial cushions.

 Treatment :

Operative correction is usually required

between 4 to 6 years of life. It is also performed with help of heart lung machine. Initially defect in mitral valve is closed. Then septal defect is repaired with patch of pericardium.

III. ANOMALOUS DRAINAGE OF

PULMONARY VEINS :
It is due to failure of incorporation of sinus

venosus in to the atrium proper.

This defect is in the upper part of the septum

near where a large vein (the superior vena

cava) brings blue blood from the upper body to the right atrium.

 Right pulmonary veins enter the superior

vena cava and in turn enter in to right atrium.

left pulmonary vein may also anomalously

enter the superior vena cava.

TREATMENT : A single anomalous pulmonary vein may be harmless and does not require treatment.

 If required, it can be corrected by insertion of prosthetic patch. So, defect is closed and pulmonary veins are made to enter the left atrium.