Atrial septal defect - symptoms and signs

Atrial septal defect

Atrial septal defect

Atrial septal defect

 

 

Atrial septal defect is one or more openings in the interatrial septum through which blood is dumped from left to right, pulmonary hypertension and heart failure develops. Symptoms and signs include exercise intolerance, shortness of breath, weakness, and atrial arrhythmias. Often, soft systolic murmur is heard in the II — III intercostal space to the left of the sternum. The diagnosis is based on echocardiography. Treatment consists of closing the defect surgically or through a catheter. Endocarditis prophylaxis is usually not required.

 

Atrial septal defects make up about 6-10% in the structure of congenital heart defects. Most cases are isolated and sporadic, but some are part of the genetic syndrome.

 

DMPD can be classified by location: a secondary defect of the septum [defect in the oval window - in the central part of the interatrial septum], venous sinus defect, or primary defect [defect in the antero-lower part of the septum, is the form of an endocardial shaft defect].

 

To understand the hemodynamic changes in case of atrial septal defect, one should understand intracardiac hemodynamics in normal conditions. Firstly, a left-right discharge of blood takes place in the DEMP. Most of the small ASD spontaneously closes during the first years of life. Nevertheless, with large defects, the right atrium and ventricular volume are overloaded, the pressure in the pulmonary artery, pulmonary vascular resistance increases, and the right ventricular hypertrophy develops. Atrial fibrillation may develop later. Ultimately, increased pressure in the right heart can lead to a bi-directional discharge of blood and the appearance of cyanosis.

 

Atrial septal defect - symptoms and signs

 

 

In most cases, small ASDs are asymptomatic.With large sizes of the defect, intolerance to physical exertion, dyspnea on exertion, weakness and atrial rhythm disturbances, and sometimes a sensation of heartbeat can be noted. The passage of microemboli from the veins of the great circle of blood circulation through DMPP, often combined with arrhythmias, can lead to thromboembolism of cerebral vessels or other organs. Rarely, if a DMP is not diagnosed on time, Eisenmenger syndrome develops. At auscultation at children in II — III inter-rib to the left systolic noise is usually listened.



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