Station 3.10: OTHER COMMON CONGENITAL DEFECTS

Question 1

Clinical signs - Atrial septal defect

What are the clinical signs of Atrial septal defect

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 1

• Raised JVP
• Pulmonary area thrill
• Auscultation

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Consider:
* Pulmonary hypertension: RV heave and loud P2, + cyanosis and clubbing (Eisenmenger’s: right‐to‐left shunt)
* Congestive cardiac failure

Question 2

Discussion - Types

Describe the types Atrial septal defect?

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 2

• Primum associated with AVSD and cleft mitral valve) seen in Down’s syndrome
• Secundum (commonest)

Question 3

Discussion - Complications

Describe the complications for Atrial septal defect?

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 3

• Paradoxical embolus
• Atrial arrhythmias
• RV dilatation

Question 4

Discussion - Investigation

What investigations do you recommend Atrial septal defect?

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 4

• ECG: RBBB + LAD (primum) or + RAD (secundum); atrial fibrillation
• CXR: small aortic knuckle, pulmonary plethora and double‐heart‐border (enlarged RA)
• TTE/TOE: site, size and shunt calculation; amenability to closure
• Right heart catheter shunt calculation (not always necessary)

Question 5

Discussion - Management

Describe the management method for Atrial septal defect?

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 5

Indications for closure:
* Symptomatic: paradoxical systemic embolism, breathlessness
* Significant shunt: Qp:Qs>1.5:1, RV dilatation
Contraindication for closure:
* Severe pulmonary hypertension and Eisenmenger’s syndrome

Question 6

Discussion - closure

Describe the closure method for Atrial septal defect?

OTHER COMMON CONGENITAL DEFECTS

This young woman complains of cough and occasional palpitations. Examine her cardiovascular system

Answer 6

• Percutaneous closure device
  ⚬ Secundum ASD only, no left atrial appendage thrombus or anomalous pulmonary venous drainage, adequate rim to anchor device
• Surgical patch repair