Congenital Heart Disease

Congenital Heart Disease

AtrialSeptal Defect (ASD)


Pathology:                   Abnormal connectionbetween the left and right atrium

There are two maintypes of ASD:

Ostiumsecundum (80%): defect in centre of atrial septum (foramen ovale)

Ostiumprimum (10%): defect in lower atrial septum (involving AV valve)



Aetiology:                    Congenital, morecommon in female. Down syndrome is associated with ostium



Symptoms:                   Usuallyasymptomatic until adult hood

 Heart failure (poor feeding, failure tothrive, tachypnoea, sweating, vomiting) or

 palpations and recurrent chest infections


Signs:                              Softsystolic murmur, upper left sternal edge, fixed splitting of 2ndheart sound,

left parasternal heave, clubbing


Investigations:          ECG: Ostium primum– Left axis deviation

     Ostiumsecundum - right axis deviation, right bundle branch block

                                    Chest X-Ray:Cardiomegaly and increased pulmonary vasculature

                                    Echo: Assessesheart structure and confirms defect


Treatment:                  ConservativeManagement: Small defects with minima, shunting can be


Surgical: Closure at 4-5 years of age


Complications:          Ifsurgical correction is not undertaken, heart failure or arrhythmias may occur

Eisenmenger Syndrome (reversal of left to right shuntresulting in cyanosis)


Prognosis:                   90% close achievedby insertion of an occlusion device in the catheter laboratory

Prognosisis good once defects corrected however development of Eisenmenger Syndrome is alife threatening complication.

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