atrial and ventricular septal defects

Question 1

what are the 3 main types of VSD

Answer 1

subaortic
perimembranous
muscular

Question 2

what type of shunt occurs in VSD

Answer 2

L→R shunt

Question 3

clinical presentation of VSD

Answer 3

• pansystolic murmur lower L sternal edge
  
  • sometimes w/ thrill
• small VSD: early systolic murmur
• large VSD: diastolic rumble - due to relative MS
• signs of cardiac failure in large VSD, eventually → biventricular hypertrophy and pulmonary HT

Question 4

what is Eisenmenger syndrome

Answer 4

occurs when blood flows from the R side of the heart to the L across a structural heart lesion, bypassing the lungs

Question 5

what heart lesions result in Eisenmenger syndrome

Answer 5

ASD

VSD

PDA

Question 6

pathophysiology of Eissenmenger’s syndrome

Answer 6

• L-R shunt in heart
• over time the extra flow into the R heart and lungs → pulmonary HT
• when pulmonary pressure > systemic pressure → blood flows R-L across septal defect
• deoxy blood bypasses lungs and enters body (easier route) → cyanosis
• bone marrow responds to low oxy sats → increased RBC production → polycythaemia → more prone to clots

Question 7

Eissenmenger syndrome examination findings

Answer 7

pulmonary HT:

• RV heave
• loud P2
• raised JVP
• peripheral oedema

underlying septal defect:

• ASD: mid-systolic, crescendo-decrescendo murmur, upper L sternal border
• VSD: pan-systolic, lower L sternal border
• PDA: continuous crescendo-decrescendo machinery murmur
• arrhythmias

R→L shunt and chronic hypoxia:

• cyanosis
• clubbing
• SOB
• plethoric complexion (polycythaemia)

Question 8

management of Eissenmenger syndrome

Answer 8

• not possible to reverse
• heart-lung transplant is the only definitive treatment
• oxygen
• treat pulmonary HT - sildenafil
• treat arrhythmias
• treat polycythaemia - venesection
• prevent and treat thrombosis - anticoagulation
• prevent infective endocarditis - prophylactic abx

Question 9

VSD closure

Answer 9

• amplatazer or other occlusion device, trans-catheter
• patch closure, open heart surgery

Question 10

signs of ASD

Answer 10

• few clinical signs in early childhood, good chance of spontaneous closure
• sometimes detected in adulthood: AF, heart failure, pulmonary HT
• wide fixed splitting of S2, pulmonary flow murmur

Question 11

atrioventriculo-septal defect or endocardial cushion defect or AV canal defect

• what is it associated with
• features of defect

Answer 11

• trisomy 21
• singular AV valve w/ ostium primum ASD and high VSD

Question 12

what is shown here

Answer 12

complete atrio-ventricular septal defect