Presentation
[…] if the condition was present at the time of inpatient admission. [icd.codes]
The treatment of ASD patients is mostly dependent on the age at presentation, existence of symptoms of congestive heart failure and the degree of the shunt. [radcliffecardiology.com]
Session Title: FIT Clinical Decision Making: Interventional Cardiology 4 Abstract Category: Interventional Cardiology Presentation Number: 1261-156 2019 American College of Cardiology Foundation [onlinejacc.org]
Study limitations - The present study presents limitations that should be considered. This was an uncontrolled retrospective cohort study of a group submitted to surgery. [scielo.br]
Entire Body System
- Atrial Septal Defect
The goals were to assess the frequency of spontaneous closure of isolated secundum atrial septal defect in children and to identify predictors of spontaneous atrial septal defect closure. METHODS. [pediatrics.aappublications.org]
Sex Secundum atrial septal defect occurs more commonly in females than males, with a female-to-male ratio of 2:1. Age Secundum atrial septal defect is a congenital abnormality and, therefore, is present at birth. [emedicine.medscape.com]
atrial septal defect, and eventually a reduction in cardiac output. [jtd.amegroups.com]
Terms used to describe defect location include secundum, primum and sinus venosus atrial septal defects. Secundum atrial septal defects account for 80% of atrial septal defects and are located near the middle of the atrial septum. [mottchildren.org]
- Asymptomatic
Most patients are asymptomatic but as cardiac failure develops they may present with shortness of breath, palpitations and weakness 7. [radiopaedia.org]
The athlete was asymptomatic, with no family history of cardio-respiratory diseases and cardio-respiratory examination at rest proved normal. [minervamedica.it]
Asymptomatic children with a small shunt require only observation and occasional echocardiography (typically about every 3 to 5 yr). [msdmanuals.com]
The patient was discharged from hospital asymptomatically; nevertheless, on postoperative day 25 the patient re-applied to the emergency department with congestive heart failure symptoms. [omicsonline.org]
BACKGROUND: Atrial septal defect (ASD) can be recognized in adult age, mostly in asymptomatic or scarcely symptomatic patients. [rwjms1.umdnj.edu]
- Pain
München, Munich, Germany Search for other works by this author on: Rüdiger Lange PDF Split View Article contents Figures & tables Video Audio Supplementary Data Cite Cite Manfred Otto Vogt, Christian Nöbauer, Christian Meierhofer, Rüdiger Lange, Chest pain [academic.oup.com]
If your child has surgery, he or she will get general anesthesia and won't feel pain or be able move around during the surgery. [kidshealth.org]
We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]
- Surgical Procedure
For 6 months following catheterization or surgical closure of an ASD, antibiotics are recommended before routine dental work or surgical procedures to prevent infective endocarditis (an infection of the inner surface of the heart). [kidshealth.org]
Discussion Cardiac invasive intervention and alternative surgical procedures are potential risk factors for iASD occurrence. [omicsonline.org]
Standard Therapies Treatment Treatment is usually surgical with the use of medications limited to the period during which the patient waits for a surgical procedure. [rarediseases.org]
- Hypoxemia
Patient foramen ovale: a cause of hypoxemia in patients on left ventricular support. Ann Thorac Surg 1991: 52: 865–7. Crossref | PubMed Nguyen DQ, Das GS, Grubbs BC, et al. [uscjournal.com]
Conclusion Chronic hypoxemia secondary to R–>L shunt can be challenging to detect. TTE with bubble study remains to be the modality of choice. [onlinejacc.org]
Closure of iASD in patients with persistent right-to-left shunt with paradoxical embolus or arterial desaturation (hypoxemia) might also be reasonable. Footnotes Please note: Dr. Rogers receives speaker honoraria from Abbott Structural Heart. Dr. [interventions.onlinejacc.org]
Emergency percutaneous closure of an iatrogenic atrial septal defect causing right-to-left shunt and severe refractory hypoxemia after pulmonary vein isolation. JACC Cardiovasc Interv. 2015 ; 8 :e179–e181. doi: 10.1016/j.jcin.2015.04.023. [ahajournals.org]
[…] finding of pulmonary hypertension in a patient with an ASD, particularly in a child, should be followed by a careful investigation for other conditions that might signal the development of pulmonary vascular disease, such as chronic lung disease with hypoxemia [clinicaladvisor.com]
Respiratoric
- Dyspnea
Adults and, rarely, adolescents may present with exercise intolerance, dyspnea, fatigue, and atrial arrhythmias. A soft midsystolic murmur at the upper left sternal border with wide and fixed splitting of the 2nd heart sound (S2) is common. [merckmanuals.com]
Upon follow up at 1 month, she reported improvement in her symptoms of exertional dyspnea and fatigue, which continued to improve to minimal limitation over the 3-year follow-up period. [invasivecardiology.com]
Larger shunts may cause slow weight gain in early childhood and exercise intolerance, dyspnea during exertion, fatigue, and/or palpitations in older patients. [msdmanuals.com]
We assessed the frequency of dyspnea incidences and palpitations. [dovepress.com]
Symptoms may, however, begin any time after birth through childhood. 5 The most common symptom of ASD is dyspnea on exertion, which for most does not occur until they are in their second or third decade of life. 4 Signs or symptoms usually begin by age [uspharmacist.com]
- Respiratory Insufficiency
Rarely, they may cause symptoms in infancy, as failure to thrive, tachypnea, recurrent respiratory infections, heart failure, and respiratory insufficiency necessitating artificial ventilation ( 35 ). [jtd.amegroups.com]
Gastrointestinal
- Failure to Thrive
The closure of ASD must be performed in advance for young patients with congestive heart failure, frequent respiratory infection, failure to thrive, or significantly elevated pulmonary arterial pressure [5, 6]. [cardiothoracicsurgery.biomedcentral.com]
Figure 2 Large atrial septal defect that is measured at 21 mm on transesophageal echocardiography (A) in a 9.7 kg, 11-month-old infant with failure to thrive. [jtd.amegroups.com]
Failure to thrive caused only by a secundum atrial septal defect is, similarly, a rare occurrence. No data indicate that an uncomplicated secundum atrial septal defect can cause pulmonary vascular disease in pediatric patients. [emedicine.medscape.com]
Cardiovascular
- Heart Disease
Ventricular performance in adult after operation for congenital heart disease; in Engle, M.A.; Perloff, J ., Congenital Heart Disease After Surgery. Benefit, Residual, Sequelae; 1st ed., pp 332-343 (Yorke Medical Books, New York 1983). [paediatricaindonesiana.org]
The UAB Congenital Heart Disease Program offers the most advanced care for structural heart disease, which often requires lifetime monitoring and care. [uabmedicine.org]
disease. 6 56 Tomita-Mitchell A...Goldmuntz E 18055909 2007 4 Phenotypes with GATA4 or NKX2.5 mutations in familial atrial septal defect. 56 6 Hirayama-Yamada K...Matsuoka R 15810002 2005 5 GATA4 mutations cause human congenital heart defects and reveal [malacards.org]
University of Colorado Hospital Denver Case Study: This Atrial Septal Defect closure demonstrates the benefits of integrating ultrasound echocardiography into the procedure room to assist in the guidance of structural heart disease interventions. [cathlabdigest.com]
Congenital heart disease. In: Bonow RO, Mann D, Zipes DP, Libby P, Breunwald E, editors. Breunwarld heart disease, a text book of cardiovascular medicine. 9th ed. China: Elsevier Saunders; 2012. p. 1411–67. CrossRef Google Scholar 7. [link.springer.com]
- Heart Murmur
When signs and symptoms do occur, heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat. Often, a heart murmur is the only sign of an ASD. [pedctsurgery.ucsf.edu]
The blood flowing through the hole creates an extra noise, which is known as a heart murmur. The heart murmur can be heard when a doctor listens to the heart with a stethoscope. [kidshealth.org]
A heart murmur is an extra sound heard between heartbeats. Also, increased blood flow through the hole may make the heart get bigger. The enlarged heart can be seen on a chest X-ray or on an electrocardiogram. [kpjampang.com]
Cyanotic heart disease (Medical Encyclopedia) Dextrocardia (Medical Encyclopedia) Echocardiogram -- children (Medical Encyclopedia) Heart murmurs and other sounds (Medical Encyclopedia) Patent ductus arteriosus (Medical Encyclopedia) Ventricular septal [icdlist.com]
- Systolic Murmur
Murmurs • Pulmonary ejection systolic murmur – Increased pulmonary flow • Tricuspid murmur – is heard over left sternal edge louder on inspiration • Graham-Steell murmur – of pulmonary regurgitation if pulmonary hypertension 13. • Late systolic murmur [slideshare.net]
Typical clinical findings consisted of loud first heart sound, widely fixed split second heart sound and soft ejection systolic murmur at the upper left sternal border were heard in all cases. [paediatricaindonesiana.org]
Chest auscultation classically reveals an ejection systolic murmur heard at the left upper sternal border, attributed to increased flow across the pulmonary valve rather than blood shunting across the defect itself 7. [radiopaedia.org]
Auscultation typically reveals a grade 2 to 3/6 midsystolic (ejection systolic) murmur (see table Heart Murmur Intensity ) and a widely split, fixed S2 at the upper left sternal border in children. [msdmanuals.com]
Typically, pulmonary valve stenosis has an associated systolic ejection click, the murmur of pulmonary valve stenosis tends to be more harsh than the systolic murmur associated with an ASD, and diastole is quiet. [clinicaladvisor.com]
- Cardiomegaly
Incomplete right bundle branch block and right ventricular enlargement were found in all cases, as was cardiomegaly with increased vascular markings were found in all cases. [paediatricaindonesiana.org]
ASD also reveals - mild to moderate cardiomegaly - prominent right atrium and right ventricle 15. ECG Right axis deviation in 85% of cases Left axis deviation and prolonged PR interval seen in ostium primum Right Atrial enlargement 16. [slideshare.net]
Chest x-ray shows cardiomegaly with dilation of the right atrium and right ventricle, a prominent main pulmonary artery segment, and increased pulmonary vascular markings. [msdmanuals.com]
In patients with haemodynamically significant ASDs cardiomegaly with enlargement of right atrium and right ventricle may be present. [patient.info]
The next most common clues leading to a diagnosis of an ASD are an abnormal electrocardiogram (ECG), typically showing right ventricular hypertrophy, or an abnormal chest roentgenogram showing cardiomegaly, usually with increased vascular markings but [clinicaladvisor.com]
Urogenital
- Phenylketonuria
Maternal diseases include phenylketonuria, pregestational diabetes, methylenetetrahydrofolate reductase deficiency (MTHFR deficiency), febrile illnesses, and influenza. [emedicine.medscape.com]
Neurologic
- Dizziness
This creates a situation where the heart's upper chambers can start to beat very rapidly causing symptoms of palpitations, dizziness, fainting, and/or undue fatigue. Another possible health problem related to an atrial septal defect is stroke. [mottchildren.org]
Workup
[…] pulmonary embolism resulting in a right-to-left shunting of blood[36] Treatment[edit] Patent Foramen Ovale[edit] Most patients with a PFO are asymptomatic and do not require any specific treatment.[37] However, those who develop a stroke require further workup [en.wikipedia.org]
Blocks
- Right Bundle Branch Block
Decisive for the request for second level tests was the basic electrocardiogram, which presented a right ventricular conduction delay of the incomplete right bundle branch block type, with rsR’ pattern in lead V1 and auscultation, performed systematically [minervamedica.it]
Incomplete right bundle branch block and right ventricular enlargement were found in all cases, as was cardiomegaly with increased vascular markings were found in all cases. [paediatricaindonesiana.org]
Mild right ventricular hypertrophy Inverted P waves in Sinous Venosus type Right Bundle Branch Block is seen which is partial or complete 17. [slideshare.net]
ECG incomplete right bundle branch block (RBBB morphology with QRS duration between 110-120 ms) increased specificity with crochetage sign in the inferior (II, III, aVF) leads right precordial (V1-3) "defective T waves" describes biphasic morphology, [radiopaedia.org]
EKG Right bundle branch block, right axis deviation and p wave abnormality patterns may be noted. Echocardiogram This is an ultrasound scan of the heart that can show the defect and its size, and the degree of heart enlargement and heart pressures. [myheart.net]
- Incomplete Right Bundle Branch Block
Decisive for the request for second level tests was the basic electrocardiogram, which presented a right ventricular conduction delay of the incomplete right bundle branch block type, with rsR’ pattern in lead V1 and auscultation, performed systematically [minervamedica.it]
ECG incomplete right bundle branch block (RBBB morphology with QRS duration between 110-120 ms) increased specificity with crochetage sign in the inferior (II, III, aVF) leads right precordial (V1-3) "defective T waves" describes biphasic morphology, [radiopaedia.org]
Incomplete right bundle branch block and right ventricular enlargement were found in all cases, as was cardiomegaly with increased vascular markings were found in all cases. [paediatricaindonesiana.org]
Investigations ECG ECG may be normal in infants and children with small shunts Typical findings include a tall P wave indicating right atrial enlargement, incomplete right bundle branch block pattern (rsR' in V1), and right axis deviation. [patient.info]
A common finding in the ECG is the presence of incomplete right bundle branch block, which is so characteristic that if it is absent, the diagnosis of ASD should be reconsidered. [en.wikipedia.org]
Treatment
[…] conventional surgery as the only treatment option. [scielosp.org]
Many children with congenital heart defects don't need treatment, but others do. Treatment can include medicines, catheter procedures, surgery, and heart transplants. [icdlist.com]
Before treatment selection, all the guardians of the patients were informed of the indications, advantages and disadvantages, and specific risks of both treatments. [cardiothoracicsurgery.biomedcentral.com]
It is evident that a RCT is required to definitely confirm the superiority of one treatment over the other. [scielo.br]
[…] with that of medical treatment in an age-matched control group with unrepaired defects. [nejm.org]
Prognosis
When these differences are taken together, they do not indicate a more favorable prognosis for one group over the other. [nejm.org]
Prognosis[18] Isolated atrial septal defects repaired in childhood have excellent prognosis with survival similar to that of the general population. [patient.info]
[…] vessels visible to the periphery of the film eventual signs of pulmonary arterial hypertension chamber enlargement right atrium right ventricle note: left atrium is normal in size unlike VSD or PDA note: aortic arch is small to normal Treatment and prognosis [radiopaedia.org]
In addition to the high surgical mortality and morbidity risk, closure of a defect in the latter situation may worsen the prognosis. [emedicine.medscape.com]
FASD implantation improves outcomes in patients with ASDAPH; however, further studies are required in a large cohort of patients to determine timing of intervention, optimal fenestration size, and long-term prognosis. [advancesinph.org]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
The etiology of the ASD is largely unknown. While the majority of the book addresses closure of ASDs, one chapter in particular focuses on creating atrial defects in the fetus with hypoplastic left heart syndrome. ... [intechopen.com]
[…] iM StIll stUdInG Published on Mar 28, 2015 ATRIAL SEPTAL DEFECT ASD - CF, ETIOLOGY ,PATHO -PHYSIOLOGY, SIGNS & SYM, MANAGEMENT.....ETC ATRIAL SEPTAL DEFECT ( ASD) 1. ATRIAL SEPTAL DEFECT AKSHAY AGRAWAL 2. CONTENTS 1. Introduction 2. Defination 3. [slideshare.net]
In those where a comprehensive evaluation is performed and an obvious etiology is not identified, they are defined as having a cryptogenic stroke. [en.wikipedia.org]
Epidemiology
Epidemiology Male : Female = 1:2 Most commonly seen in children 8. [slideshare.net]
[…] hypertension for lung transplantation. 61 Gorcsan J...Griffith BP 7887718 1995 48 [Transthoracic and transesophageal echocardiography in the pre- and postoperative assessment of interatrial communication]. 61 San Roman JA...Sanchez-Harguindey L 8134694 1993 49 Epidemiology [malacards.org]
The epidemiological aspects of congenital heart disease in central and southern district of Iran. Adv Biomed Res. 2014; 3 : 233[ DOI ][ PubMed ] 2. Porter CBJ, Edwards W. [ijp.tums.pub]
Epidemiological data on individuals with congenital cardiopathy were obtained from Brazilian studies published in the literature 1 1. Rossi RIF, Manica JLL, Cardoso CO. [scielosp.org]
The Danish Civil Registration System as a tool in epidemiology. European journal of epidemiology 29, 541–549, https://doi.org/10.1007/s10654-014-9930-3 (2014). 18. Nyboe, C., Karunanithi, Z., Nielsen-Kudsk, J. E. & Hjortdal, V. E. [nature.com]
Pathophysiology
Pathophysiology 6. Clinical features 7. Investigations 8. Risk Factors 9. Management 3. Introduction Septal defects are more common eg of non cyanotic heart disease. Most common congenital heart disease in adults. [slideshare.net]
Additional hints, tips and definitions within specific codes provide extra guidance in coding anatomy, pathophysiology, or other coding directions. [books.google.de]
Sinus venosus defects, coronary sinus defects and primum ASDs (partial atrioventricular septal defect [AVSD]) are beyond the scope of this article, but many of the pathophysiological and management principles still apply. [aerjournal.com]
The objective of this contemporary review is to focus on the pathophysiologic mechanisms underlying the interatrial shunt. [jtd.amegroups.com]
An understanding of human embryology is essential for diagnosing these abnormalities, and an understanding of the pathophysiology is helpful in planning long-term treatment. [emedicine.medscape.com]
Prevention
What about preventing endocarditis? Most children with an ASD are not at increased risk for developing endocarditis. [heart.org]
Prevention In most cases, atrial septal defects can't be prevented. If you're planning to become pregnant, schedule a visit with your health care provider. This visit should include: Getting tested for immunity to rubella. [mayoclinic.org]
For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures to help prevent an infection of the heart valves. [hopkinsmedicine.org]