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ATRIOVENTRICULAR SEPTAL DEFECTS

ATRIOVENTRICULAR SEPTAL DEFECTS. OSTIUM PRIMUM AND ATRIOVENTRICULAR CANAL OR ENDOCARDIAL CUSHION DEFECTS. OSTIUM PRIMUM DEFECT Lower portion of atrial septum,overlies mitral and tricuspid valves ATRIOVENTRICULAR SEPTAL DEFECT

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ATRIOVENTRICULAR SEPTAL DEFECTS

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  1. ATRIOVENTRICULAR SEPTAL DEFECTS OSTIUM PRIMUM AND ATRIOVENTRICULAR CANAL OR ENDOCARDIAL CUSHION DEFECTS

  2. OSTIUM PRIMUM DEFECT • Lower portion of atrial septum,overlies mitral and tricuspid valves ATRIOVENTRICULAR SEPTAL DEFECT • AV canal defects or endocardial cushion defects consists of contiguous atrial and ventricular septal defect with abnormal AV valve

  3. OSTIUM PRIMUM DEFECT • Combination of left to right shunt across atrial defect and mitral insufficiency.Shunt is moderate to large,mitral insufficiency is mild to moderate. AV SEPTAL DEFECTS • Left to right shunt at both atrial and ventricular level with additional shunting from left ventricle to right atrium

  4. CLINICAL MENIFESTATIONS OSTIUM PRIMUM DEFCETS • Asymptomatic, similar to secundum ASD • Exercise intolerance,easy fatiguability • Recurrent pneumonias • Cardiac enlargement with hyperdynamic precordium • Normal or accentuated 1st sound,wide fixed splitting of second heart sound,sysytolic ejection murmur, mid diastolic murmur at lower left sternal border

  5. COMPLETE AV CANAL DEFECTS • Congestive heart failure • Recurrent chest infections • Failure to thrive • Precordial bulge • Normal or accentuated first heart sound • Wide fixed splitting of second heart sound • Pulmonary systolic ejection murmur

  6. CXR • Cardiac enlargement • Large pulmonary artery with increased pulmonary blood flow ECG • Biventricular hypertrophy • RSR pattern ECHOCARDIOGRAPHY • Right ventricular enlargement • Absence of echo in septal defects

  7. COMPLICATIONS • Pulmonary vascular obstructive disease • Pulmonic stenosis MANAGEMENT • Ostium primum defects are closed by insertion of patch prosthesis • AV septal defects should be treated surgically during infancy COMPLICATIONS OF SURGERY • Heart block, worsening of MR

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