Ravilya_Pediatrics_ Cardiology Asd

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def

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present

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ds

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tx

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A case presentation of ASD

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A case presentation of ASD (atrial septal defect): a older child appears with history of tiring easily after walking upstairs or running.A younger child may appear with failure to thrive.

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Examination (Important for Board examination

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Examination reveals a medium-pitched systolic ejection murmur rarely accompanied by thrill. Murmur is best heard in (L) middle and upper sternal border, widely split 2nd heart sound in all phases of respiration. It is duet o increased flow through pulmonary artery, not to blood flow across the ASD. (Important for Board examination

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CHEST X-RAY:EKG

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MOST liKELY DIAGNOSIS: atrial septal defect (ostium secundum defect). CHEST X-RAY: mild cardiomegaly, increased pulmonary flow. EKG: (R) ventricular hypertrophy, right-axis deviation, a minor right-ventricular conduction delay (rsR pattern in right precordial leads

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DIAGNOSIS CONFIRMED BY:

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DIAGNOSIS CONFIRMED BY: echocardiogram

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TREATMENT:

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TREATMENT: surgical repair of ASD by open heart surgery is performed after first year and before child begins schooL After that, pulmonary hypertension usually develops. Surgery is indicated in all symptomatic patients and also for asymptomatic patients with a Qp : ~ ratio 2:1or more

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Antibiotic
prophylaxis:

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Antibiotic
prophylaxis:not indicated in isolated secundum ASD because infective endocarditis is very rare.

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Key words:

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tiring easily after activities, failure to thrive, medium-pitched systolic ejection murmur, widely split t>d heart sound in all phases of respiration, usually no thrill

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Most common cardiac anomaly in Down syndrome:

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42.
Most common cardiac anomaly in Down syndrome: atrioventricular septal defects (or endocardial cushion defects, atrioventricular canal defects, ostium primum defects).

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Clinical manifestations of atrioventricular (AV) septal defects

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Clinical manifestations of atrioventricular (AV) septal defects (very important for Board examination):
(a)
Complete AV septal defects: patient appears with congestive cardiac failure and intercurrent pulmonary infection during infancy. Physical examination reveals mild cyanosis, failure to thrive, enlarged liver, moderate-to-marked cardiomegaly, a precordial bulge, a palpable systolic thrill at lower left sternal border, a widely split 2nd heart sound, a low-pitched mid-diastolic rumbling murmur is audible at lower left sternal border.
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Ostium primum defects:
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In mild left-to-right shunt: patient may be asymptomatic.
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In moderate left-to-right shunt and mild mitral insufficiency: patient hassimilar manifestations like secundum ASD with an additional mitral insufficiency murmur in apical region.
(iii) In large left-to-right shunt and severe mitral insufficiency: patient appears with history of easy fatigability, exercise intolerance, and recurrent pneumonias. Physical examination reveals hyperdynamic precordium; a wide, fixed-splitting of 2nd heart sound; pulmonary systolic ejection murmur; low-pitched mid-diastolic rumbling murmur at lower left sternal border due to increased flow through the AV valves; a harsh holosystolic murmur that radiates to left axilla due to mitral insufficiency.

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Laboratory diagnosis and treatment for atrioventricular (AV) septal defects:

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Laboratory diagnosis and treatment for atrioventricular (AV) septal defects:
(a)
Laboratory diagnosis:
CHEST X-RAY: moderate-to-severe cardiomegaly, increased pulmonary blood flow.
EKG: characteristic left axis deviation; biventricular or right ventricular hypertrophy.
DIAGNOSIS CONFIRMED BY: echocardiogram

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Key words:

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Key words: congestive cardiac failure, intercurrent pulmonary infections, mild cyanosis, widely split 2nd heart sound, low-pitched mid-diastolic rumbling murmur, andleft axis deviation

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TREATMENT:

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TREATMENT:
(i)
Ostium primum defects: atrial septal defect is closed by insertion of a patch prosthesis; cleft in mitral valve is repaired by direct suture.
(ii)
AV septal defects: surgery must be performed during early infancy because pulmonary vascular disease develops as early as 6 to 12 months of age. Total surgical correction is performed, i.e., atrial and ventricular defects are patched and AV valves reconstructed. If patient is small or total surgical correction is risky, pulmonary artery banding is performed as palliative procedure to reduce the pulmonary overcirculation.

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complica( kaplan)

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