Académique Documents
Professionnel Documents
Culture Documents
1. OToole JD, Reddy PS, Curtiss EI, Shaver JA. The mechanism of splitting of the second
heart sound in atrial septal defect . Circulation 1977; 56: 1047-53.
Exmenes auxiliares.
EKG:
En todos: PR prolongado. 1
CIA tipo OS: Eje QRS a la derecha, Hipertrofia VD (rSR, rsR en
V1 y V2 con duracin normal de QRS), BCRD o BIRD.
CIA tipo seno venoso: Desviacin de eje de onda P a la izquierda
(P neg III).
CIA tipo OP: HARI asociado. 1
HTAP: onda P prominente en II + hipertrofia VD.
Variedad de arritmias auriculares.
1. Thiln U, Carlson J, Platonov PG, Havmller R, Olsson SB. Prolonged P wave duration in
adults with secundum atrial septal defect: a marker of delayed conduction rather than increased
atrial size? Europace 2007; Suppl 6: vi105-8.
Exmenes auxiliares.
CXR:
Cardiomegalia.
Dilatacin de AD y VD. (Aumento del contacto esternal en el
perfil).
Dilatacin del tronco de la arteria pulmonar y sus ramas con
aumento de la circulacin pulmonar.
En caso de enfermedad vascular pulmonar (Eisenmenger):
Dilatacin del rbol arterial pulmonar central con
hipovascularizacin perifrica (imagen del rbol de invierno) y
disminucin del tamao cardaco.
1. PEDRO CHIESA, CARMEN GUTIRREZ, JORGE TAMBASCO, PABLO CARLEVARO,
ALEJANDRO CUESTA. Comunicacin interauricular en el adulto. REV URUG CARDIOL 2009;
24: 180-193.
Exmenes auxiliares.
Ecocardiografia:
Demostrar CIA y variedad anatmica.
Repercusin hemodinmica: Dilatacin, etc.
Descartar lesiones asociadas.
Retorno venoso pulmonar. Anmalo?
CIA OS menor de 0,5 cm2. Cierre percutneo?
PAP por doppler. Doppler: Shunt. (I-D, bidireccional o invertido)
1. Klewer SE, Samson RA, Donnerstein RL, et al. Comparison of accuracy of diagnosis of
congenital heart disease by history and physical examination versus echocardiography. Am J
Cardiol 2002;89:1329.
A secundum atrial septal defect is demonstrated from the apical four-chamber view. In this
case, the defect is readily apparent on two-dimensional imaging (A). Left-to-right shunting
through the defect is confirmed (B) with color Doppler imaging. LA, left atrium; LV, left ventricle;
RA, right atrium; RV, right ventricle.
A sinus venosus defect is shown. A:
This four-chamber view demonstrates
a dilated right heart, but suggests that
the atrial septum is intact. B: Color
Doppler imaging reveals a defect in
the most superior portion of the atrial
septum, near the entrance of the
superior vena cava (arrow). C: Flow
through anomalous pulmonary vein
as it enters the left atrium at the site
of the defect (arrows) is shown. LA,
left atrium; LV, left ventricle; RA, right
atrium; RV, right ventricle.
From the apical four-chamber view (A), marked dilation of the right atrium (RA) and
right ventricle (RV) is evident, but the atrial septum appears intact. B: By superior
angulation of the scan plane, color Doppler imaging (arrow) was able to demonstrate a
sinus venosus defect. LA, left atrium; LV, left ventricle.
A sinus venosus atrial septal defect
in an infant is detected from the
subcostal view. By adjusting the
scan plane to record the superior
and posterior portion of the atrial
septum, the defect can be seen.
Note the relationship between the
septal defect and the entrance of
the superior vena cava (SVC)
(arrow). LA, left atrium; RA, right
atrium.
In the presence of an
intracardiac shunt, Qp/Qs
provides a means to quantify
the magnitude of shunting. In
this example from a patient
with a large secundum atrial
septal defect, stroke volume
(SV) through the pulmonary
(left) and aortic (right) valves
are measured and the Qp/Qs
is determined.
Primum atrial septal defect is often
associated with a cleft mitral valve. A: The
mitral orifice is demonstrated from the
short-axis view. B: By scanning slightly
more apically, the cleft in the anterior
leaflet is demonstrated (arrow). C: Such
patients often have a posteriorly directed
jet of mitral regurgitation. Ao, aorta; LV,
left ventricle.
Exmenes auxiliares.
RMN:
Puede ser de utilidad cuando los hallazgos del ecocardiograma
son dudosos. Se logra visualizacin directa del defecto septal y de
la llegada de las venas pulmonares. Adems permite cuantificar el
volumen del ventrculo derecho y su funcin.
1. Rosas M, Attie F. Atrial septal defect in adults. Timely Top Med Cardiovasc Dis 2007; 11: E34.
2. Kharouf R, Luxenberg DM, Khalid O, Abdulla R. Atrial septal defect: spectrum of care. Pediatr Cardiol 2008;
29: 271-80.
3. Murphy JG, Gersh BJ, McGoon MD, Mair DD, Porter CJ, Ilstrup DM, et al. Long-term outcome alter surgical
repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990; 13: 1645-1650.
Indicaciones de cierre.
Indicaciones: En uno o mas casos.
Dilatacin de cavidades derechas.
Qp/Qs mayor de 1.5/1.
Embolia paradojal.
HTAP leve a moderada y progresiva.
RVPulm menor a 2/3 partes de la RVSist. O test (+) a vasodilatadores.
CIA pequeo asociado a arritmia, embolia o aneurisma.
Contraindicaciones:
Negativa del paciente.
Procesos infecciosos locales, locoregionales o sistmicos.
Sndrome de Einsenmenger.
Dx de CIA en la gestacin.
Disfuncin severa de VI.
1.Rosas M, Zabal C, Garcia-Montes J, Buendia A, Webb G, Attie F. Transcatheter versus surgical closure of secundum atrial septal
defect in adults: impact of age at intervention. A concurrent matched comparative study. Congenit Heart Dis 2007; 2: 148-55.
2. Providncia R, Quintal N, Costa M, Botelho A, Silva J, Seca L, et al. Echocardiographic assessment of secundum-type atrial septal
defects in the adult: role in treatment decisions. Rev Port Cardiol 2008; 27: 1263-73.
3. Rao PS. When and How should atrial septal defects be closed in adults?. J Invasive Cardiol 2009; 21: 76-82.
4. Vida VL, Berggren H, Brawn WJ, Daenen W, Di Carlo D, Di Donato R, et al. Risk of surgery for congenital heart disease in the adult:
a multicentered European study. Ann Thorac Surg 2007; 83: 161-8.
31-year-old woman after insertion of 40-mm Amplatzer septal occluder (AGA Medical
Corporation), which is in good position.
Percutaneous closure of an atrial septal defect using an Amplatzer device is demonstrated in
two patients. Such devices appear on echocardiography as echogenic structures within the area
of the atrial septum. A: Two devices (arrows) were needed to occlude two separate defects. Color
Doppler imaging can be used to detect residual shunting across the defects. LA, left atrium; LV,
left ventricle.
During device closure of an atrial septal defect, intracardiac echocardiography is often use to guide
deployment of the device. This series of echocardiograms demonstrates placement of an Amplatzer closure
device across a secundum atrial septal defect. After the left atrial (LA) device is positioned, the structure is
secured against the atrial septum before the right atrial component is engaged. Then, the deployment catheter
is released, allowing the device to straddle the septum and obscure the defect.
Guidance of ASD device closure by intracardiac echocardiography. Ao, aorta; ASD, atrial septal defect; LA,
left atrium; RA, right atrium; 1c, long access sheath; 2c, end of access sheath in the left atrium; 3c, guidewire;
1d und 2d, delivery cable with the left-sided countercluder opened; 1e und 2e, implanted device still
connected to the delivery cable; 1f und 2f, device in its final position.
Cierre quirrgico.
Esternotoma media o submamaria derecha. Por atriotomia D.
Cierre con parche de pericardio autologo o heterologo.
CIA OP: Valorar la posicin anatmica del NAV. Plastia de la
valva mayor de la mitral. (ETE TO)
CIA Seno venoso: Redireccionar flujo pulmonar a AI.
Si HTAP moderada: Cierre con parche valvulado.
Si FA: Maze.