Adult Congential Heart Disease

Question 1

what is the difference between ostium primum and secundum ASDs?

Answer 1

the secundum is in the fossa ovalis and is more common (75%) the primum ASD is absence of part of the endocardial cushion

Question 2

why do patients with ASDs get mitral regurgitation?

Answer 2

if ostium primum defect, it’s due to a cleft abnormality in the AV border in secundum defect, there is an associated with MVP

Question 3

what are the subtypes of VSD?

Answer 3

see image

there are 4 main subtypes.

the muscular commonly closes itself

the membranous one also closes spontaneously often

Question 4

why do we avoid closure of many congenital cardiac conditions once they have pulm HTN?

Answer 4

this is because there is a problem with the pressures. Once you hit high pressure, if you then off load the heart, there is bad vasospasm

Question 5

what’s the biggest issue long term for TOF repair?

Answer 5

the timing of the pulmonary valve replacement is a major management dilemma

overall, there are lots of things that occur (including mild RVOT obstruction) but the Pulm regurg is the major issue

Question 6

what is Ebstien’s anomaly?

Answer 6

this is a congenital cause of tricuspid regurgitation

it is atrialisation of the right ventricle (that is to say, the tricuspid valves kind of “invade” into the RV and cause an obstruction)