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Arterial Septal Defect (Asd)

An arterial septal defect (ASD) is an opening in the wall between the two upper chambers (atria) of the heart. The document reports a case of a 29-year-old female patient with a history of heart disease who presented with breathlessness, chest pain, and fever for 3 weeks. Examination and tests revealed an ASD. Treatment involved medication, bed rest, and oxygen. ASDs are usually closed either percutaneously or surgically to prevent complications like arrhythmias and pulmonary hypertension. Follow-up is needed to monitor for issues like device problems, arrhythmias, or pulmonary vascular disease.

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Rhahima Syafril
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© © All Rights Reserved
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42 views

Arterial Septal Defect (Asd)

An arterial septal defect (ASD) is an opening in the wall between the two upper chambers (atria) of the heart. The document reports a case of a 29-year-old female patient with a history of heart disease who presented with breathlessness, chest pain, and fever for 3 weeks. Examination and tests revealed an ASD. Treatment involved medication, bed rest, and oxygen. ASDs are usually closed either percutaneously or surgically to prevent complications like arrhythmias and pulmonary hypertension. Follow-up is needed to monitor for issues like device problems, arrhythmias, or pulmonary vascular disease.

Uploaded by

Rhahima Syafril
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ARTERIAL SEPTAL DEFECT (ASD)

CASE REPORT
PATIENT IDENTITY
NAME
AGE
SEX

: MS. D
: 29 YO
: FEMALE

HOSPITALIZED : AUGUST, 28th 2016


MR
: 599656

CHIEF COMPLAIN

Breathlesness
hospitalized

since

weeks

before

PRESENT ILLNESS HISTORY


3 weeks before hospitalized patient complain abaut
breathlesness. Breathlesness felt continously. Patient
haved complain about pain in a chest. Pain felt like push
heavy weight. Pain just in the chest and didnt felt in
other part of the body.
2 weeks before hospitalized patient get fever. Fever
felt continously. a week before hospitalized patient get
cought. Cought was productive. Patient also felt loss of
body weight and loss of apatite, fatigue (-)
7 years ago, patient was diagnose heart disease, but
patient didnt control regulary.

PAST ILLNESS HISTORY


Hipertension (-)
Sianotic (-)
DM (-)

FAMILY PASS ILLNESS HISTORY


There is no family history that corelate this
patient (-)

PHYSICAL EXAMINATION
General appearence : Moderete illness
Consiusness
: Composmentis
Vital sign
Blood pressure
: 110/70 mmHg
Heart rate
: 96 x/i
Respiration rate
: 28 x/i
Temperature
: 36 C

HEAD
Pale

conjuctive : -/ Yellow sclera : -/ Mouth : sianotic (-)


JVP 5+3 cmH2O

THORAX
HEART
Inspection
: Ictus cordis (-)
Palpation
: Ictus cordis (+) SIC 4
midclavicula
Percution
Right border : Parasternalis line dextra, SIC
4
Left border : Midclavicula line sinistra, SIC
5
Auskultation : S1 and S2 regullar, murmur
sistolyc (+), gallop (-)

LUNG
Inspection
: Simetric (+/+), mass (-),
Palpation
: Vocal Fremitus (+/+)
Percution
: Sonor in all Field of thorax
Auskultation :Vesikuler (+/+), ronkhi (-/-),
wheezing (-/-)

STOMACH
Inspection : mass (-), scar (-)
Auscultation : intestine sound (+)
Percution
: tympany
Palpation
: Hepatomegaly (-),
splenomegaly (-)

EKSTREMITY

Warm, CRT < 2 minute, Oedema (-)

WORKING DIAGNOSIS

Dyspnoe ec suspect congenital heart defect

ADDITIONAL EXAMINATION
Blood routine
Electrocardiogram
Rontgen thorax
Echocardiografi

LABORATORY FINDING
Eritosite
:
Leukocyte
Hemogloblin :
Hematocrite :
Platelet
:

5.360.000 /uL
: 12.500 /uL
15 g/dl
45 %
215.000/ uL

ELECTROCARDIOGRAM

Appear :
Irama : sinus, reguler.
Ritmik : 115 bpm (sinus takikardi)
P wave : wide 0,08 second (normaly)
Length 1 mm
Interval PR : 0,16 second ( normaly)
Interval QRS : 0,08 second ( normaly)
Complex QRS: ST segmen normaly
T wave : Normaly

RONTGEN THORAX

Right identity
R marker
Opacity is good
CTR > 50% (52%)
Heart waist (+)
Hiperbronchovascular

ECHOCARDIOGRAFI

APPEAR ECHOCARDIOGRAFI

DIAGNOSIS

Atrial Septal Defect

TREATMENT
Non farmacology:
Bed rest ( fowler position )
O2 2 liter nasal canul
Farmacology :
Furosemid 3x 20 mg
Digosin 1x 0,25 mg
Ranitidin 2 x 50 mg

ARTERIAL SEPTAL DEFECT


ANATOMY
Normal heart

Arterial Septal Defect

DEFINITION
ASD is an opening or hole (defect) in the wall
(septum) between the hearts two upper chambers
(atria)

ETIOLOGY

PATOFISIOLOGY

RECOMMENDATIONS FOR EVALUATION


OF THE UNOPERATED PATIENT
Class I
1.ASD should be diagnosed by imaging techniques
with demonstration of shunting across the defect
and evidence of RV volume overload and any
associated anomalies. (Level of Evidence: C)
2.Patients with unexplained RV volume overload
should be referred to an ACHD center for further
diagnostic studies to rule out obscure ASD,
partial anomalous venous connection, or coronary
sinoseptal defect. (Level of Evidence: C)

Class IIa
1. Maximal exercise testing can be useful to
document exercise capacity in patients with
symptoms that are discrepant with clinical
findings or to document changes in oxygen
saturation in patients with mild or moderate
PAH. (Level of Evidence: C)
2. Cardiac catheterization can be useful to rule out
concomitant coronary artery disease in patients
at risk because of age or other factors. (Level of
Evidence: B)

Class III
1. In younger patients with uncomplicated
ASD for whom imaging results are adequate,
diagnostic cardiac catheterization is not
indicated. (Level of Evidence: B)
2. Maximal exercise testing is not
recommended in ASD with severe PAH. (Level
of Evidence: B)

MANAGEMENT STRATEGIES
Recommendations for Medical Therapy
Class I
1. Cardioversion after appropriate
anticoagulation is recommended to attempt
restoration of the sinus rhythm if atrial
fibrillation occurs. (Level of Evidence: A)

2. Rate control and anticoagulation are


recommended if sinus rhythm cannot be
maintained by medical or interventional
means. (Level of Evidence: A)

RECOMMENDATIONS FOR INTERVENTIONAL


AND SURGICAL THERAPY

Class I
1. Closure of an ASD either percutaneously or
surgically is indicated for right atrial and RV
enlargement with or without symptoms. (Level
of Evidence: B)
2. A sinus venosus, coronary sinus, or primum
ASD should be repaired surgically rather than
by percutaneous closure. (Level of Evidence: B)
3. Surgeons with training and expertise in
CHD should perform operations for various
ASD closures. (Level of Evidence: C)

Class IIa
1. Surgical closure of secundum ASD is reasonable
when
concomitant surgical repair/replacement of a tricuspid
valve is considered or when the anatomy of the defect
precludes the use of a percutaneous device. (Level of
Evidence: C)
2. Closure of an ASD, either percutaneously or
surgically,
is reasonable in the presence of:
a. Paradoxical embolism. (Level of Evidence: C)
b. Documented orthodeoxia-platypnea. (Level of
Evidence:
B)

Class IIb
1. Closure of an ASD, either percutaneously or surgically,
may be considered in the presence of net left-to-right
shunting, pulmonary artery pressure less than two
thirds systemic levels, PVR less than two thirds systemic
vascular resistance, or when responsive to either
pulmonary vasodilator therapy or test occlusion of the
defect (patients should be treated in conjunction with
providers who have expertise in the management of
pulmonary hypertensive syndromes). (Level of Evidence:
C)
2. Concomitant Maze procedure may be considered for
intermittent or chronic atrial tachyarrhythmias in
adults with ASDs. (Level of Evidence: C)

Class III
1. Patients with severe irreversible PAH and
no evidence
of a left-to-right shunt should not undergo
ASD closure.
(Level of Evidence: B)

INDICATIONS FOR CLOSURE OF


ATRIAL SEPTAL DEFECT
Small ASDs with a diameter of less than 5 mm and no
evidence of RV volume overload do not impact the natural
history of the individual and thus may not require closure
unless associated with paradoxical embolism.
and closure is usually indicated to prevent longterm
complications such as atrial arrhythmias, reduced
exercise tolerance, hemodynamically significant TR,
rightto left shunting and embolism during pregnancy, overt
congestive cardiac failure, or pulmonary vascular disease
that may develop in up to 5% to 10% of affected (mainly
female) individuals.

CATHETER INTERVENTION
The development of percutaneous transcatheter
closure
techniques has provided an alternative method of
closure
for uncomplicated secundum ASDs with
appropriate morphology.
the majority of secundum ASDs
can be closed with a percutaneous catheter
technique. When
this is not feasible or is not appropriate, surgical
closure is
recommended.

RECOMMENDATIONS FOR POST


INTERVENTION FOLLOW-UP
Class I
1. Early postoperative symptoms of undue fever, fatigue,
vomiting, chest pain, or abdominal pain may represent
postpericardiotomy syndrome with tamponade and
should prompt immediate evaluation with echocardiography.
(Level of Evidence: C)
2. Annual clinical follow-up is recommended for patients
postoperatively if their ASD was repaired as an adult
and the following conditions persist or develop:
a. PAH. (Level of Evidence: C)
b. Atrial arrhythmias. (Level of Evidence: C)
c. RV or LV dysfunction. (Level of Evidence: C)
d. Coexisting valvular or other cardiac lesions. (Level
of Evidence: C)
3. Evaluation for possible device migration, erosion, or
other complications is recommended for patients 3
months to 1 year after device closure and periodically
thereafter. (Level of Evidence: C)
4. Device erosion, which may present with chest pain or
syncope, should warrant urgent evaluation. (Level of
Evidence: C)

RECOMMENDATION FOR
REPRODUCTION
Class III
1. Pregnancy in patients with ASD and
severe PAH
(Eisenmenger syndrome) is not
recommended owing to
excessive maternal and fetal mortality and
should be
strongly discouraged. (Level of Evidence: A)

ACTIVITY
Patients with small ASDs and without PAH have
normal
exercise capacity and do not need any limitation
of physical
activity. In those patients with large left-to-right
shunts,
exercise is often self-limited owing to decreased
cardiopulmonary
function.

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