Atrial and Ventricular septal defects

Question 1

Sinus Venosus Atrial septal defect. What it means and its repair.

Answer 1

Usually an interatrial communication caused by a deficiency of the wall between the superior vena cava (SVC) and the right-sided pulmonary veins.

SVASD is commonly associated with anomalous pulmonary venous connection (APVC) of some or all of the pulmonary veins, causing additional left-to-right shunting.

Repaired by surgery, redirecting the pulmonary vein back to LA.

Post-op risks: SA node dysfunction, SVC stenosis or pulmonary vein stenosis.

Question 2

Most common Atrial septal defect

Answer 2

Ostium Secundum ASD

Question 3

List the atrial septal defects (5)

Answer 3

Ostium Secundum ASD (Left–>Right)

Patent Foramen Ovale (RIGHT–>Left)

Ostium Primum (L->R)

Sinus Venosus

Common/Single atrium (total septal agenesis)

Question 4

Single atrium

Answer 4

Commonly associated with heterotaxy syndrome, associated with major malformation of other organs and organ systems.

Mixed blood and chronic poor oxygenation,

Question 5

Left to right atrial shunts, pathophysiology and progression

Answer 5

Large shunts –> extra blood from the high pressure left atrium to the right, chronic volume overload of right atrium and right ventricle

Eventual RV dilation and failure.

Question 6

Auscultation of a Atrial septal defect.

Answer 6

Causes a FIXED S2 SPLIT.

due to constantly fixed increased volume on the RV relative to the left.

Question 7

What is the most common congenital heart abnormality?

Answer 7

Ventricular SD.

Associated with other syndromes, like Downs’

Question 8

Where is the VSD usually located?

Answer 8

The membranous portion (90%)

MOST will spontaneously close in childhood.

Question 9

Auscultation of VSD

Answer 9

Hard holosystolic murmur, loudest at the TRICUSPID area.

May have palpable thrill.

Question 10

Progression of VSD

Answer 10

Usually symptomless at birth, and becomes apparent after a few weeks.
Babies fail to thrive, sweaty and tachypnoeic while feeding.

L->R shunt,
RV hypertrophy
Pulmonary hypertension
Eventual R->L shunt, Eisenmenger synd. Hypoxia, Death.

Question 11

Treatment of VSD

Answer 11

Conservative treatment and observation, most close within the first year as heart grows.

Transcatheter closure with an umbrella shaped occlude

Surgery and closure with native or bovine pericardium.