Atrial Septal Defect (ASD)
A 3D image of Atrial Septal Defect
Atrial septal defect (ASD) is a type of congenital heart disease that enables blood flow between two upper compartments of the heart called the left and right atrium. Normally, the right and left atriums are separated by a septum called the inter-atrial septum. If this septum is defective or absent, then oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart, or vice versa. However, an Atrial Septal Defect (ASD) may not produce noticeable signs or symptoms, especially if the defect is small.
Symptoms of Atrial Septal Defect (ASD)
In Children
Usually asymptomatic
Large defects may cause
Congestive heart failure,Recurrent respiratory infection,Exertional dyspnoea (Difficulty in breathing while doing any physical activities), fatiguability
In Adults
Palpitation-Fast beating of the heart,(Atrial fibrillation),Excertional dyspnoea (Difficulty in breathing while doing any physical activities),Eisenmenger’s syndrome (The process in which a left to right shunt caused by a congenital heart defect in the fetal heart)
Physical Examination
JVP (Jugular Venous Pulse)-V wave prominent (left atrium patter),Right ventricular (lower chamber of the heart) lift,Palpable pulmonary artery pulsation,Wide and fixed splitting S2-second heart sound (A2-P2 do not move close on expiration),Pulmonary soft superficial ejection systolic murmur in second left intercostals space, radiating to left shoulder,Tricuspid mid-distolic flow murmur when shunt > 2:1,Right sided S3 in large left to right shunts,Mitral incompetence in ostium primum defect.
X-Ray
X-Ray image of ASD
Increased pulmonary vascularity,Enlarged main pulmonary artery,Small ascending aorta,Right ventricular enlargement,LA enlargement in ostium primum defect
Echo
2D Echo image of ASD
3D Echo image of ASD
Dilated RV, RA and LA,Paradoxical septal motion (RV volume overload),Inter artrial shunt shown by contrast / colour Doppler,Visualization of the defect.
Treatment
Shunt closure by Septal occluder shown in figure below if shunt exceeds 1.5:1 but not for Eisenmenger syndrome.
Dacron patch repair or transvenous umbrella closure when thoractomy contraindicated.
An image of ASD Repair
ASD Repair with umberla closure
Associated Defects
MVP in 20% cases of Secundum ASD,Lutembacher syndrome – ASD with mitral stenosis,Triology of Fallot-ASD + Pulmonary stenosis + RVH,Pentalogy of Fallot- ASD+Fallot tetralogy
Signs of a Developing Eisenmenger Complex
Decreasing intensity of pulmonary / tricuspid flow murmurs,Increasing intensity of P2 : development of single S2.,Appearance of Graham-Steel murmur(A heart murmur typically associated with pulmonary regurgitation. It is a high pitched early diastolic murmur heard best at the left sternal edge in the second intercostal space with the patient in full inspiration.),Development of central cyanosis-the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen,Clubbing-also known as drumstick fingers and watch-glass nails (later)
In Further
|
Type |
Location |
ECG-Feature |
Associated Abnormalities |
| Primum | Lower septum A.V. Valve | Left axis deviation, AV block | Cleft mitral valve |
| Secundum | Fossa ovalis | Incomplete RBBB normal or right axis | Mirtal valve prolapse |
| Sinus Venosus | High atrial septum near SVC | Ectopic atrial rhythm, negative P in lead III | Annomalous pulmaonary venous connections |
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