1. ATRIAL SEPTAL DEFECT
BY DR.ANAND

2. Normally, oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle, then is pumped into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped out to the body through the aorta.

3. An atrial septal defect allows oxygen-rich (red) blood to pass from the left atrium, through the opening in the septum, and then mix with oxygen-poor (blue) blood in the right atrium.

4. DEFINITION
An atrial septal defect is an opening in the atrial septum, or dividing wall between the two upper chambers of the heart known as the right and left atria..

5. GROSS SPECIMENS

6. EMBRYOLOGY
The heart is forming during the first 8 weeks of fetal development. It begins as a hollow tube, then partitions within the tube develop that eventually become the septa (or walls) dividing the right side of the heart from the left. Atrial septal defects occur when the partitioning process does not occur completely, leaving an opening in the atrial septum.

7. HEMODYNAMICS
RT.ATRIUM RECEIVES BLOOD FROM SUP. & INF.VENA CAVA & FROM LT. ATRIUM
RT.ATRIUM ENLARGES

8. HEMODYNAMICS
LARGE VOL OF BLOOD FROM RT.ATRIUM PASSES THRU NORMAL TRICUSPID VALVE & PULMONARY VALVE
DELAYED DIASTOLIC MURMUR(LOW LT STERNAL BORDER)
RT.VENTRICLE ENLARGES
PULMONARY EJECTION MURMUR

9. HEMODYNAMICS PULM. VALVE CLOSES LATE & P2 IS DELAYED
RV IS FULLY LOADED,SO FURTHER RISE IN RV VOLUME CANNOT OCCUR
WIDELY SPLIT S2
FIXED SPLIT S2
ACCENTUATED S2

10. PRESENTATION recurrent chest infections fatigue sweating
rapid breathing
shortness of breath
poor growth

11. ON EXAMINATION INSPECTION PARASTRNL IMPULSE PALPATION
SYSTOLIC THRILL AT 2ND LT SPACE

12. AUSCULTATION WIDE FIXED SPLIT S2 ACCENTUATED P2
ESM AT LT 2nd & 3rd INTERSPACES
DELAYED DIASTOLIC MURMUR AT LOW LT INTERSPACE

13. CXR FINDINGS MOD. CARDIOMEGALY RA ENLARGEMENT RV ENLARGEMENT
PROMINENT MAIN PULM ARTERY
PLETHORIC LUNG FIELDS

14. ECG CHANGES
RT AXIS DEVIATION
RT VENT HYPERTROPHY
rsR’ PATTERN IN V1

15. ECHO PICTURES

16. SEVERITY ASSESMENT
INTENSITY OF THE TWO MURMURS
THE HEART SIZE

17. COMPLICATION PULMONARY HYPERTENSION(ABOVE 20 YEARS)
DISAPPEARANCE OF DIASTOLIC MURMUR
APPEARANCE OF PULM EJECN CLICK
LOUD PALPABLE P2
P2_STILL WIDELY SPLIT

18. MANAGEMENT MEDICAL ANTIBIOTICS FOR CHEST INFECTIONS
DIGOXIN TO INCREASE WORK OF HEART
DIURETICS TO REDUCE PRELOAD

19. SURGICAL REPAIR:DEVICES

20. REPAIR

21. ROBO REPAIR