1. Atrial Septal Defect
R3 이재연

2. Definition Pathophysiology Atrial Septal Defect
A hole of variable size in the atrial septum
A patent foramen ovale functionally closed is excluded
Pathophysiology
left-to-right shunting  increasing pulmonary blood flow
Over time, the increased pulmonary overcirculation leads
- pulmonary vascular occlusive disease
- pulmonary hypertension
- right ventricular failure
- atrial arrhythmias

3. Types of ASD
Most common type

4. Types of ASD Fossa ovalis defect (ostium secundum defect)
Ostium primum defect
Subcaval defect (sinus venosus defect ,
superior vena caval defect)
Coronary sinus defect

5. ASD. Secundum, Multiple
ASD. Secundum

6. Morphology of Atrial Septal Defect
1. Cardiac chamber
. Enlarged thick right atrium
. Increased diastolic RV
. LV dynamic abnormality
2. Mitral valve
. Mitral prolapse
. Mitral incompetence
. Cleft mitral leaflet
3. The lungs
. Pulmonary vascular disease
. Compress smaller airways
4. Cardiac conditions
. All varieties of CHD coexist
. Mitral valvar disease
. Tricuspid incompetence

7. Clinical Features 1. Prevalence
. 10% of CHD, most common CHD in adults
. M : F = 1 : 2
. Fossa ovalis defect is most common (80%)
2. Symptoms and signs
. No symptoms & signs when Qp/Qs < 1.5
. Effort breathlessness and respiratory infections

8. Diagnosis of ASD AUSCULTATION - Wide fixed split S2, Accentuated P2
CXR moderate cardiomegaly, RAE, RVE,
prominent pulmonary artery
ECG - Rt axis deviation
- RVE
- rsR’ pattern in V1
Echocardiography

9. Natural History of ASD 1. Survival 5-15% die in 3rd decade
Premature death with CHF
Rarely paradoxical emboli
2. Pulmonary hypertension
3. Functional status
1% with large ASD have
symptoms during 1 year
4. Spontaneous closure
Uncommon after 1 year
5. Changes in Qp/Qs with time
6. Rt & Lt ventricular function
7. AV valvar dysfunction
8. Supraventricular arrhythmia
AF in adult
Sinus node dysfunction
9. Systemic hypertension
No definite causes,
but increased incidence

10. Management Medical Mx Prompt treatment of respiratory tract infections
Antiarrhythmic for AF or supraventricular tachycardia
Usual measures for hypertension, coronary disease, or HF
Operative repair usually with a patch of pericardium or of prosthetic material, or percutaneous transcatheter device closure, ideally in children ages 3 ~ 6, should be advised for all pts with uncomplicated secundum atrial septal defects in whom there is significant left-to-right shunting,
i.e.) pulmonary-to-systemic flow ratios 2.0:1.0.