acyanotic CHD

Question 1

LIST acyanotic

Answer 1

ASD

Question 2

Atrial septal defect
ASD Definition:

Answer 2

Defect in interatrial septum

Question 6

Types of ASDs

Answer 6

secundum
primum
sinus venosus

Question 6

Ostium secundum defect
occurence
where
association

Answer 6

-The commonest type.
-Lies in the middle part ofthe septum at the site of fossa ovalis.
- Association: may be with Holt Oram syndrome (Absent radii , l 51 degree
heart block , ASD)

Question 7

Ostium primum defect

Answer 7

• Lies in the lower part of the septum
• Association: usually with cleft of mitral valve leaflet.
• mitral regurge.

Question 8

Hemodynamics of ASD

Answer 8

Blood is shunted from left atrium to right atrium
-right ventricle -pulmonary blood flow
(more with primum defects).

Question 9

General manifestations of ASD

Answer 9

1- Asymptomatic in most cases.
2- Large ASD (especially primum defect) may present with features of increased pulmonary blood flow .

Question 10

Auscultation in ASD
2 things

Answer 10

1. pulmonary area
   a- wide fixed splitting of S2:
   -wide splitting due to large filling of right ventricle & fixed (not vary with
   respiration) due to constant filling of right ventricle in all phases of respiration

b- murmur of a relative pulmonary stenosis:
- ejection systolic.
-soft.
- no thrill.
- no propagation
- with accentuated P2*

2- Apex: pansystolic murmer of mitral regurge in ostium primum defect.

Question 10

Investigations
cxr
ecg

Answer 10

1- Chest X-ray:
-Cardiomegaly with RVH & RAD.
- Plethoric lungs.

2- ECG:
- RVH & RAD.
- Right bundle branch block is common.

Question 11

Treatment of ASD

Answer 11

1- Medical:
-Control heart failure (diuretrics, digoxin, vasodilaters).
- Prophylaxis against infective endocarditis usually not needed.
- Antibiotics for chest infections.
-Follow up with ECG & Echo to confirm to spontaneous closure.

2- Surgical: Transcatheter or open heart surgical closure at 3-5 years.

Question 12

Prognosis of ASD

Answer 12

40% of ostium secundum defects close in I st four years spontaneously

Question 13

ventricular septal defect (VSD) definition

Answer 13

Defect in interventricular septum

Question 14

Types ofVSDs:

Answer 14

membranous
muscular
supracristal

Question 15

hemodynamics of VSD

Answer 15

Blood is shunted from left ventricle to right ventricle
___.t pulmonary blood flow ___.t input to left atrium
and left ventricle.

Question 16

General manifestations

Answer 16

1- Small VSD: Usually asymptomatic, discovered accidentally.
2- Large VSD: - Features of increased pulmonary blood flow
- Congestive heart failure with tachypnea, tachycardia
& enlarged tender liver.

Question 17

Precordial Examination vsd

Answer 17

• Evidence of biventricular enlargement (L VH & RVH)
• Systolic thrill on lower left sternal border.

Question 18

Auscultation VSD

Answer 18

1- Murmer ofVSD:
- pansystolic.
- on lower left sternal border.
- propagate all over the heart.
- Harsh (louder if small).

2- Pulmonary area: Accentuated P2 & soft systolic murmer indicate pulmonary hypertension.

3- Apical: Soft mid diastolic murmer may be heard due to relative mitral stenosis.

Question 19

Investigations VSD
cxr
ecg

Answer 19

1- Chest X-ray:
-Large VSD ~Cardiomegaly with biventricular enlargement (LVH & RVH).
& increased pulmonary vascular markings (Plethora).

2- ECG:
-Large VSD ~ Biventricular enlargement (LVH & RVH) & LAD.

Question 20

Treatment VSD
medical
surgical

Answer 20

1- Medical:
-Control heart failure (diuretrics, digoxin, vasodilaters).
- Prophylaxis against infective endocarditis.
- Antibiotics for chest infections.
-Follow up with ECG & Echo to confirm spontaneous closure.

2- Surgical:
-Types:
a- Palliative: Pulmonary artery banding (less favoured).
b- Direct closure of the defect.

Question 21

indication for surgery vsd

Answer 21

a- Symptomatic large defects.
b- Growth failure uncontrolled medically.
c- Pulmonary hypertension.
d- Supracristal VSD (aortic cusp may herniate inside resulting in aortic regurge).

Question 22

Prognosis VSD

Answer 22

30-50% of small defects (especially muscular) close spontaneously within I 51 2-years.