Asd investigations and management

Asd investigations and management

1. Investigations and Management

2. Investigations options….. ECG Chest x-ray Echocardiography Cardiac catheterization

3. ECG

4. ECG findings…….. Right axis deviation rSr ’ or rSR ’ in V1 Predominant s- waves in left precordial leads(V5- V6) Features of arrythmia

5. Echocardiography

6. Echo. Findings……. Transthoracic 2D- IAS can be imaged from apical and subcostal four chamber view Subcostal view is best Echo drop out in mid portion for ASD secundum Color doppler imaging shows directly flow from LA to RA

7. Cardiac catheterization

8. Findings……. Now not diagnostic, used for device closure In ASD catheter passes through from RA to LA Small ASD- RA pressure tracing is normal, oxygen step up more than 10 % Large ASD- when RA and LA pressure tracing same and mean pressure tracing less than 3 mmHg

9. Continued….. When oxygen saturation 15% or more in RA than SVC or IVC, ASD is diagnosed In absence of ASD , RA oxygen saturation increase in- VSD with TR Rupture sinus valsalva aneurysm

10. Chest X-Ray

11. Findings….. Normal in small ASD Large ASD- cardiomegaly with RA and RV enlargement Lung vascularity increase Pulmonary conus full In pulmonary hypertension, lungs field become oligaemic (outer third, pruned tree like appearance)

12. MANAGEMENT

13. Medical management If asymtomatic – no treatment If complication developes - O2-inhalation diuretics spironolactone ACE inhibitor digoxin

14. Interventional procedure DEVICE CLOSURE Small and moderate size defect Closed percutanously through right heart Uses different devices Most recently- Amplatzer device anbiotic cover given before procedure Aspirin and clopidogrel given for 6 month after procedure

15. Continued….. Must fulfill following criteria- ASD less than 40mm diameter, clear AV valve and pul.veins and rim of atrial septum (<5mm)

16. Continued…. Contraindications… Ostium primum ASD Sinus venosus ASD Anomalous pulmonary venous drainage Severe pulmonary HTN

17. SURGICAL CLOSURE between age 5 to 10 yrs To avoid complcation - RV-failure, arrythmia , pul . HTN Qp:Qs ratio >2:1 Older pt surgical procedure is still worthwhile Surgery by partial sternal split with minimal skin incision by pericardial or Teflon patch

18. TAKE HOME MESSAGE…… Small ASD asymptomatic upto adulthood Large ASD symptomatic in adulthood Ostium secundum most common variety Examination- ESM and wide and fixed splitting 2 nd heart sound 2-D echo- echo dropout of interatrial septum with T sign and left to rt color flow on color doppler Percutanous device closure or surgical patch closure is definitive treatment