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Paediatrics finals > Atrial septal defect > Flashcards

Atrial septal defect Flashcards

1
Q

What is the second most common congenital heart defect?

A

Atrial septal defect

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2
Q

What is ASD?

A

Septum between left and right atrium is not formed completely

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3
Q

What shunt occurs in ASD?

A

Left to right shunt

Pressure in left atrium is greater than in the right

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4
Q

In terms of cyanosis, what is ASD?

A

Acyanotic congenital heart disease

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5
Q

Why is ASD acyanotic?

A

Oxygenated blood from left atrium is forced into the right atrium

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6
Q

What might happen to the ASD if it is very small?

A

May close on its own

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7
Q

How many live births have an ASD?

A

9 in 1000

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8
Q

What percentage of CHDs do ASDs account for?

A

5-10%

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9
Q

Which sex is more prone to ASD and which one in particular?

A

Female

Ostium secundum

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10
Q

Describe the pathophysiology of ASD in terms of atrial septum embryology

A

Formed from 2 separate endocardial cushions in the 4th week of gestation

Primary atrial septum = septum primum (grows cranial to caudal), this closes off the ostium primum

The ostium secundum develops again from the atrial roof and grows downwards towards the septum primum

Foramen ovale = space between the septum primum and secundum

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11
Q

When does the foramen ovale close?

A

Shortly after birth

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12
Q

Why does the foramen ovale close?

A

Change in vascular resistance

Systemic BP increases as pulmonary pressure decreases with a decrease in RA pressure

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13
Q

List the 5 types of ASD in order of how commonly they occur

A 
Patent foramen ovale 
Ostium secundum defect
Ostium primum defect
Sinus venosus defect
Coronary sinus defect
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14
Q

Describe ostium secundum defect

A

When there is incomplete occlusion of ostium secundum by septum secundum or too much reabsorption of septum primum by the atrial roof

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15
Q

Describe ostium primum defects

A

When septum primum fails to fuse with the endocardial cushions allowing blood to travel from LA to RA

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16
Q

Name and describe the two types of ostium primum defects

A

Complete AVSD - Common AV valve but spanning from atria to ventricles
Partial AVSD - Defect just of the ostium primum with intact ventricular septum

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17
Q

What can sinus venous defects be split into?

A

Superior

Inferior

18
Q

Describe superior sinus venous defect

A

When Superior vena cava opening runs on top of oval fossa of atrial septum
Renders SVC draining blood from both LA and RA

19
Q

Describe inferior sinus venous defect

A

Less common
Occurs with IVC orifice overrides LA and RA
Can coexist with abnormal communication between IVC and right superior pulmonary vein

20
Q

Describe coronary venous sinus defect

A

Absence of a roof in the coronary sinus
Partial or focal
Allowing for transmission between coronary sinus and left atrium

21
Q

List the risk factors for atrial septal defect

A 
FH
Maternal smoking in 1st trimester
Maternal cocaine and alcohol use 
Maternal diabetes
Maternal rubella
22
Q

What inheritance pattern does ASD present?

A

Autosomal dominant

23
Q

What congenital conditions are ASDs linked with?

A

Treacher Collins syndrome

Thrombocytopenia absent radii (TAR) syndrome

24
Q

List the symptoms of large ASD in children

A

Tachypnoea
Poor weight gain
Recurrent chest infections

25
Q

List the symptoms of untreated large ASDs in adults

A 
Exercise intolerance
Palpitations
Recurrent chest infections
Fatigue
Syncope
26
Q

What examination findings are there of an ASD?

A

Murmur - soft ejection systolic murmur, best heard over the pulmonary region, wide, fixed splitting second heart sound, diastolic rumble in the lower left sternal edge

27
Q

What is the differential of a ASD?

A

AVSD
VSD
Innocent murmur
Pulmonary stenosis

28
Q

What is an innocent murmur?

A

Soft and musical

29
Q

Describe the pulmonary stenosis murmur

A

More turbulent

30
Q

What investigations would you do for an ASD?

A

ECG
Transthoracic echocardiogram
Cardiac MRI and CT
CXR

31
Q

What are some possible ECG changes in a large ASD?

A

Tall P wave - RA enlargement
Right bundle branch block
Right axis deviation
Atrial fibrillation or flutter

32
Q

What information does a transthoracic echocardiogram show?

A

Size of ASD

Direction of blood flow

33
Q

What can cardiac MRI measure?

A

Pulmonary vs systemic blood flow ratio

Informs us of how significant the shunt is

34
Q

Describe the management of ASD

A

If ASD <15mm then spontaneous closure should occur within 12 months of birth

In adults with no signs of heart failure and a small defect - continue to monitor by echo every 2-3yrs

If presenting with arrhythmia, control rhythm with drugs and anticoagulated before definitive surgical treatment

Diuretics for children with heart failure

Surgical closure is the definitive management - patients with ASD>1cm - percutaneous or open

35
Q

When is surgical closure not recommended?

A

For patients with pulmonary hypertension as this can induce RV failure if the ASD closes up

36
Q

What does percutaneous closure require?

A

Adequate septum to be present in order to hold device in place

37
Q

List the complications of percutaneous closure

A

Arrhythmia
Atrioventricular block
Thromboembolism

38
Q

List the indications for surgical closure

A

TIA/stroke
Ostium primum defects
Sinus venous defects
Coronary sinus defects

39
Q

What are the complications of large atrial septal defects

A 
Arrhythmia 
Pulmonary hypertension
Eisenmenger syndrome 
Cyanosis
Peripheral oedema
TIA/stoke
40
Q

What is the life expectancy for a child with an ASD diagnosed in childhood?

A

The same as normal

Paediatrics finals (37 decks)

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