2 - Paeds - CVS - Atrioventricular Septal Defect

Question 1

3 types?

Answer 1

pAVSD (see ASD deck)
complex congenital HD eg tricuspid atresia
complete AVSD

Question 2

Complete AVSD - commonly seen in? defect is where? causes what?

Answer 2

common in Downs
middle heart, with one 5-leaflet common valve between atria and ventricles, which tends to leak

this also causes pulm HTN

Question 3

Complete AVSD - presents how? what does ECG show?

Answer 3

antenatal USS
OR cyanosis at birth
OR HF at 2-3 weeks
OR routine echo for newborn Downs screening

ECG - superior axis dev (both lead 1+2 point down)

Question 4

Complete AVSD MGMT

Answer 4

treat HF medically and surgical repair at 3-6m

Question 5

Complex congenital HD - most commonly what? effectivity of heart chambers? what happens to blood in heart?

Answer 5

most commonly tricuspid atresia
only LV effective
‘common mixing’ of systemic and pulm venous return in left atrium

Question 6

complex CHD - clinical features/presentation

Answer 6

cyanosis in newborn if duct-dependent, or child may be well at birth and become cyanosed/SOB

Question 7

Complex CHD - mgmt

Answer 7

complete surgical correction not poss in most as only 1 functioning ventricle

early palliation to maintain supply to low pressure

Question 8

Down syndrome - AVSD %? any CHD %?

Answer 8

AVSD - 15-20%

CHD - 45%

Question 9

3 murmurs possibly heard

Answer 9

ESM - inc fl pulm valve and S2 splits
Mid-diastolic murmur - LLSE - inc fl mitral valve
Apical holosystolic murmur - L axilla radiation - mitral insuff