cardio #4
Terms
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- Atrial septal defect ASD
-
incomplete closure b/w the two upper chambers of the heart
*blood flow b/w atria causing some heart chambers to pump extra blood -
ASD can cause Pulmonary HTN
What is that? - the heart can dialate, the muscle can become weak, and the pressures in the pulmonary arteries can increase due to increase in blood flow
- Eisenmenger's syndrome
- the pressures in the right side of the heart are high enough that blood may begin to flow from the right to the left side of the heart
- Secundum atrial sepal defect
-
*most common 80%
*caused by failure of part of the atrial septum to close completely during development of the heart
*results in a "hole" b/w chambers -
Sinus venosus artial septal defect:
where-
assoc with-
meaning- -
-junction of the superior vena cava and right atrium
-anomalous drainage of the pulmonary v.
-one or more of the pulmonary vv carries oxygenated blood from the lungs to the right atrium instead of the left - ASD: blood can flow ("Shunt") across the hole from the left atrium to the right resulting in ...
-
enlargement of the right atrium and ventricle due to the extra blood ==
increasing pulmonary blood flow -
ASD:
symptoms -
fatigue
shortness of breath - ASD findings:
-
*F:M= 3:1
****Systolic murmur with FIXED SPLIT S2*** heard best at the 2nd LICS
*will increase pulmonary flow across pulm. valve
*a lg ASD can cause MID-DIASTOLIC RUMBLE (increase flow across the AV valve - ASD can be differentiated from Pulmonary stenosis b/c
-
PS will have an ejection click
easily heart over left shoulder (back) - ASD is confirmed by:
- echocardiogram- which visualizes the actual defect and estimates its size, as well as the conn. of the pulm. vv
- Cardiac Catheterization is used for ASD when:
- inconclusiive echocardiographic examination or associated anomalies, that req further eval.
-
ASD closure:
spontaneous closure within 1st yr-
by 18 months-
after 3 yrs-
lesions > 2.0 Qp:Qs occur at what age -
-50%; 100% if <3mm if < 3 months
-80% if small 5-8 mm
-most won't close; >8mm=rare
-3-5 yrs - Why do you electively close ASD if not closed spontaneously by school-age?
-
b/c of pulmonary vascular obstructive disease
*the pulmonary arteries become thickened and obstructed due to increased flow, from left to right for many yeart - Therapy for sinuse venosus ASD:
-
Open heart surgery
*b/c there is no chance of spontaneous closure and these pt's are not candidates for transcatheter closure b/c of location of ASD -
Surgical Treatment:
indications for surgical repair- -
-right ventricular overload
a shunt fraction >2.0 as est. by echo
(amount of blood going in2 pulm
circulation/amount going out to
the systemic circulation)
elective closure prior to a child start
ing school - Surgical options for ASD closure:
-
*direct suture repair (small ASD)
*patch repair (more common)
-use pt's own pericardium, bovine periicardium, or synthetic mmaterial (Gore-Tex, Dacron) - Surgical (dr. Mann):
-
-infants/children who become symptomatic
-moderate-lg ASDs remaining at 4-5 y/o
-small ASD in an older child or adult
-heart lung bypass (patch repair)
-catheter reapair - Medication for ASD:
-
digitalis
diuretics
SBE prophylaxis
-d/c 6 months post-op
-not indicated for isolated ASDs -
Septal Occluder for ASD:
not able to do in lg defects -
*balloon catheter (use ultrasound) est. size
*fabric-covered wire frame over ASD
*wedges the ASD b/c the two parts
*6-8wks normal tissues grows in and over the defect
*90% success
*faster recovery, no thoracotomy -
Tetralogy of fallot:
abnormalities -
*Ventricular septal defect (SYSTOLIC murmur along LSB)
*Pulmonary Stenosis
*aorta "overrides" the ventricular septal defect
*right ventricular hypertropy
-Palliative: Blalock-Taussig (aortopulmonary shunt)
-Definitive: VSD patch repair and pulmonary valvulotomy - TOF effects:
-
*cyanosis dev. as ductus closes at birth (not able to circulate enough blood now)
*"Tet spells" (paroxysmal(sudden attacks) hypercyanotic episodes):
irritable to low 02 levels
sleepy or unresponsive
can be treated by comforting and
knee-ches position - TOF repair:
-
>95% infants successfully in 1st yr of life
*closure of VSD; augmentation of outflow tract
repaiir can lead to pulmonary insufficiency - TOF diagnostic eval:
-
*CXR and EKG (USELESS)
*pediatric cardiology consult
*echoocardiograpy has replaced cath studies
*MRI occasionally -
CXR heart configureations:
TOF-
transposition-
TAPVR (total anomalous pulm venous return)-
coractation- -
-"cuer en sabot" (wooden shoe)
-"egg-on-end"
-"snowman"
-"backwards 3 sign" ( and rib notching)