acyanotic CHD Flashcards
LIST acyanotic
ASD
Atrial septal defect
ASD Definition:
Defect in interatrial septum
Types of ASDs
secundum
primum
sinus venosus
Ostium secundum defect
occurence
where
association
-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)
Ostium primum defect
- Lies in the lower part of the septum
- Association: usually with cleft of mitral valve leaflet.
- mitral regurge.
Hemodynamics of ASD
Blood is shunted from left atrium to right atrium
-right ventricle -pulmonary blood flow
(more with primum defects).
General manifestations of ASD
1- Asymptomatic in most cases.
2- Large ASD (especially primum defect) may present with features of increased pulmonary blood flow .
Auscultation in ASD
2 things
- 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.
Investigations
cxr
ecg
1- Chest X-ray:
-Cardiomegaly with RVH & RAD.
- Plethoric lungs.
2- ECG:
- RVH & RAD.
- Right bundle branch block is common.
Treatment of ASD
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.
Prognosis of ASD
40% of ostium secundum defects close in I st four years spontaneously
ventricular septal defect (VSD) definition
Defect in interventricular septum
Types ofVSDs:
membranous
muscular
supracristal
hemodynamics of VSD
Blood is shunted from left ventricle to right ventricle
___.t pulmonary blood flow ___.t input to left atrium
and left ventricle.
General manifestations
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.
Precordial Examination vsd
- Evidence of biventricular enlargement (L VH & RVH)
- Systolic thrill on lower left sternal border.
Auscultation VSD
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.
Investigations VSD
cxr
ecg
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.
Treatment VSD
medical
surgical
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.
indication for surgery vsd
a- Symptomatic large defects.
b- Growth failure uncontrolled medically.
c- Pulmonary hypertension.
d- Supracristal VSD (aortic cusp may herniate inside resulting in aortic regurge).
Prognosis VSD
30-50% of small defects (especially muscular) close spontaneously within I 51 2-years.
