atrial septal defect  
   

definition

- definition of scimitar syndrome

- definition of atrial septal aneurysm

definition of scimitar syndrome

 

definition of atrial septal aneurysm

   

history

- จะมีอาการเมื่อความรุนแรงระดับใด

จะมีอาการเมื่อความรุนแรงระดับใด

- Qp:Qs > 1.8-2.0 with symptoms or large shunt

   

physical examination

- ตรวจร่างกายอะไรบ้าง

ตรวจร่างกายอะไรบ้าง

   

epidemiology

- prevalence of type of ASD

prevalence of type of ASD

   

classification

- classification of ASD

- classification of coronary sinus defect

- classification of sinus venous defect

- classification of partial anomalous pulmonary venous connection

classification of ASD

- isolation

- combination with other congenital heart disease

 

classification of coronary sinus defect

- persistent LSVC

- coronary sinus defect

 

classification of sinus venous defect

- superior sinus venosus defect

- inferior sinus venous defect

 

classification of partial anomalous pulmonary venous connection

   

pathogenesis

- pathogenesis of ASD

pathogenesis of ASD

   

investigation

- CXR

- echocardiography

- EKG

- CT

- MRI

- cardiac catheterization

- bronchoscopy

 

CXR

- CXR finding

CXR finding

- large right atrium and right ventricle

- enlarged pulmonary trunk

- pulmonary vascular marking increase

echocardiography

- choice of echocardiography และการเลือกใช้

- ASD size classification

choice of echocardiography และการเลือกใช้

- TTE

- TEE ให้เลือกใน equivocal cases and PAPVC or scimitar syndrome

 

ASD size classification

- trivial < 3 mm

- small 3-6 mm

- moderate 6-8 mm

- large > 8 mm

EKG

- EKG finding

EKG finding

- normal sinus rhythm and incomplete RBBB with right axis deviation

- atrial flutter

- atrial fibrillation

MRI

- indication MRI

indication MRI

- anatomical detail of pulmonary venous connection

- calculation of Qp:Qs

cardiac catheterization

- indication cardiac catherization

indication cardiac catheterization

- pulmonary hypertension to test vasodilator response

- age > 35-40 yr

- arterial sat < 97% by usual finger sensor

bronchoscopy

- indication bronchoscopy

indication bronchoscopy

- history of hemoptysis

- recurrent pulmonary infection

   

treatment

- แนวทางการรักษา ASD แต่ละประเภท

- observe

- supportive Rx

- transcatheter closure

- surgery

แนวทางการรักษา ASD แต่ละประเภท

- secundum ASD

** small size

** moderate to large size

observe

- ขนาดของ ASD และ spontaneous closure

ขนาดของ ASD และ spontaneous closure

- 4-5 mm : > 50% closure (size 3 mm closure 30%??)

- > 10 mm : no closure

supportive Rx

- medication

- treatment of pulmonary hypertension

 

medication

- medication ให้ยาอะไรบ้าง

- การเลือก antithrombotic drug

- indication ATB prophylaxis

medication ให้ยาอะไรบ้าง

- diuretics

- ACEI or ARBS

- antithrombotic drug

- IE prophylaxis

 

การเลือก antithrombotic drug

- aspirin

- warfarin

 

indication ATB prophylaxis

- use of prosthetic material or device

- residual defect near prosthetic device in dental or respiratory procedure

treatment of pulmonary hypertension

- definition of irreversible pulmonary hypertension

- treatment of pulmonary hypertension after cardiac catheterization

definition of irreversible pulmonary hypertension

 

treatment of pulmonary hypertension after cardiac catheterization

- normal

- elevated PVR

transcatheter closure

- indication transcatheter closure

- contraindication unsuitable for catheter closure

- type of catheter-based closure

indication transcatheter closure or occlusion device

 

contraindication unsuitable for catheter closure

- failed closure

- inadequate septal rim

- sinus venosus defect, primum or coronary sinus ASD

 

type of catheter-based closure

- Amplatzer septal occluder

- Helex septal occluder : < 17 mm

  ** จะให้ antithrombotic หลังทำ transcatheter closure 6 mo เพื่อลดการเกิด thrombus formation

surgery

- indication surgery

- contraindication surgery

- candidate for surgery

- approach of surgery

- technique of surgery

indication surgery

- defect > 1 cm

- Qp:Qs > 1.5:1

** small ASD with special indication

** for adult with patent foramen ovalve and stroke younger < 60 yr with

 

contraindication surgery

- PVR > 10-12 woods units/m2

- advanced pulmonary vascular obstructive disease (pulmonary hypertension)

 

candidate for surgery

- control disease : age 3-5 yr (BW > 15 kg)

- uncontrolled disease : age 1-2 yr

 

approach of surgery

- open surgery

- MIS

technique of surgery

- technique of surgery in sinus venosus ASD with PAPVR

- technique of surgery in other combination of congenital heart disease

technique of surgery in sinus venosus ASD with PAPVR

- single-patch technique

- two-patch technique

 

technique of surgery in other combination of congenital heart disease

   

complication

- complication of ASD

- complication of transcatheter closure

- complication of surgery

complication of ASD

- heart failure

- pulmonary hypertension

- volume overload

- paradoxical emboli and stroke

- other complications

 

complication of transcatheter closure

 

complication of surgery

- postpericardiotomy syndrome

- atrial arrhythmia

- embolic event

- other complications

   

follow up

- f/u asymptomatic ASD by size อย่างไร

- f/u ASD by type อย่างไร

f/u asymptomatic ASD by size อย่างไร

- small < 6 mm

- moderate 6-8 mm

- large > 8 mm

 

f/u ASD by type อย่างไร

- patent foramen ovale : no f/u

- trivial ASD : no f/u

- clinically significant ASDs (> 3 mm) : by echo เมื่อ signs or symptoms of increasing shunt q 1-2 yr

** significant ASD

** sign of symptom of increasing shunt