Congenital

Question 1

What are two types of Atrial Septal Defects?

Answer 1

1. Fossa ovalis or secundum

2. Primum type or persistent ostium primum

Question 2

What is an atrial septal defect, secundum type?

Answer 2

Defect in the fossa ovalis

Hemodynamics:
RA, RV, and PA pressures normal in childhood–rarely elevated

Left to right atrial shunt–>increased pulmonary flow

Pathologic complex

1. RIght atrium and ventricle hypertrophied and dilated
2. Dilation of tricuspid and pulmonary orifices and pulmonary trunk

Split S2

Question 3

What is an atrial septal defect primum type?

Answer 3

Defect distal to fossa ovalis close to mitral and tricuspid valves

Hemodynamics

1. RV and PA pressures normal or slightly elevated, RA pressure normal
2. Left to right atrial shunt, slight right to left
3. Increased Pulmonary flow
4. Increased pulmonary vascular resistance and pulmonary hypertension may develop in adult life

Pathologic Complex

1. Cleft aortic leaflet of mitral valve
2. RA and RV hypertrophied and dilated
3. Dilation of tricuspid and pulmonic orifices
4. LV hypertrophy present if mitral regurgitation or subaortic stenosis

Associated with down syndrome
Split S2

Question 4

Ventricular Septal Defect

Answer 4

Most common congenital cardiac defect -most self resolve; larger lesions may lead to LV overload and HF

Hemodynamics

1. RV and PA pressures normal if defect small
2. RV and PA pressures increase if large defect
3. Left to Right shunt
4. Increased pulmonary flow
5. Increased pulmonary vascular resistance and pulmonary hypertension causing right to left shunt and cyanosis, if defect is large

Pathological Complex

1. defect usually subaortic
   - may be anywhere in septum
2. RA hypertrophied
3. RV hypertrophied and dilated
4. LA and LV hypertrophic and dilated
5. dilation of pulmonic orifice and pulmonary trunk’

Associated with fetal alcohol syndrome

Question 5

Patent Ductus Arterious

Answer 5

Communication between aorta and left pulmonary artery distal to isthmus

Hemodynamic

1. RV and PA pressures normal or elevated
2. LA and LV pressures normal or elevated
3. RA pressure normal
4. L to right shunt
5. Increase pulmonary flow
6. If pulmonary vasucalr resistance high, may have bidirectional shunt at ductus level

Pathologic complex

1. Without pumonary hypertension, LA and LV hypertrophied and dilated
2. dialtion of PA with pulmonary tension, RA and RV hypertrophied and dilated, LA and LV vary

Question 6

Isolated Pulmonary Stenosis

Answer 6

f