Adult Congenital Heart Diseases Flashcards
ASD
- open communication b/w atria via a defect in the intra-atrial septum
- second most common adult congenital disease after bicuspid AV, usually asymp. until adulthood
- left to right shunt (originally)
- complications: atrial arrhythmias, paradoxical embolus, cerebral abcess, right heart failure, pulmonary HTN –> Eisenmenger syndrome
patent foramen ovale
often of little significance
= foramen covered by septum primum but is not sealed shut in 20% of normal subjects
which echo is needed for operative closure and ddx of ASD?
trans-esophageal echo
two most common in adult cardiology?
- Bicuspid aortic valve
- myxomatous mitral valve (MVP)
Eisenmenger sydrome
- irreversible pulmonary HTN
- results in reversal from left to right, to right to left shunting due to noncompliance of the lungs
- this can happen with any kind of shunting, i.e. ASD, VSD, etc.
most common type of ASD?
- secundum ASD, occurs in the middle of atria
- 70% of ASD’s
- due to defects in foramen ovale, not usually assoc. w/ other cardiac defects
- usually closed with catheterization and plug
second most common ASD?
= primum defect
- at bottom of atrial septa
- 15-20% of patients
- much more serious
- sometimes involves portions of top of ventricular septum and mitral/tricuspid valve= endocardial cushion defect (or AV canal defect- could be in any chamber through putting probe in)
- Almost always associated with defects in the AV valves or Ventricular septum (almost always assoc. w/ other defects)
Sinus Venosus ASD
third most common, about 5% of ASD’s
- located high in the right atrium
- 90% are assoc. w/ anomalous pulmonary vein insertion (one or more of four pulmonary veins enters into right atria rather than left)
Two types of sinus venosus ASDs?
Superior Sinus Venosus - SVC defect
Inferior Sinus Venosus- IVC defect
Scimitar Syndrome
Triad:
- Partial anomalous venous return
- Hypoplasia of a lobe of the right lung
- Thoracic aorta>Pulmonary artery collaterals
Pathophys of shunting in ASD?
- shunt depends on the size of the defect, the compliance of the right and left ventricles, and the phases of contraction (systole/diastole, atrial ventricular, early or late in phase)
- Most shunts start L>R, but all large shunts have some R>L *(even small shunts will have a small amount of R>L)
- Shunt flow leads to a “useless circuit” of blood through the defect
- This leads to right heart volume overload, well tolerated for many years, but can cause pulmonary HTN
sizes of ASDs?
lesions 2:1 will become symptomatic and req. surgical repair by age 40
clinical manifestations of ASD?
- atrial arrhythmia: see increased HR, due to scarred/irritated SA node
- see 20% due to atrial fibrillation/flutter that increases with advancing age, A fib in older pt. is more imp.
- see risk of embolic events, including stroke. paradoxical stroke, systemic emboli
- migraine cephalgia: might be assoc. though no evidence to back this up
- pulmonary HTN and Eisenmenger syndrome can result, which requires >2.5:1 shunt
cyanosis?
know that shut is occuring in right to left - usually have Eisenmenger sydnrome or pulmonary valve stenosis
PE of ASD?
- Physical findings are related to three things:
- Size and location of defect
- Size of the shunt
- Pulmonary Artery Pressure (resistance)
** feel heaves at left sternal border, or retrosternal heaves (over the pulmonic valve) **
Shock = when you can feel a sound
Heart sounds: hear wide fixed split S2 (ASD makes splitting stay equal due to shunting), increased P2 with pulmonary HTN-
- usually heart S1 split w/ increase in tricuspid component
