ASD: Signs and Symptoms

ASD is a congenital heart defect in which the IAS • The size of an ASD and its location in the
(interatrial septum) of atrias does not close heart will determine the symptoms .
completely. • Most children who have ASDs seem
healthy and appear to have no symptoms.
- Ostium secundum ASD: Infants and children with larger, more
- Ostium primum ASD: severe ASDs, however, may show some of
- Sinus venosus ASD: the following signs or symptoms:
• poor appetite
• poor growth
• fatigue
• shortness of breath
• cyanosis (mixing of deoxygenated and
oxygenated blood)  will not be present
at birth (left to right shunt)
• lung problems and infections, such as
pneumonia.

PERSISTANT common AV canal: - the tricuspid and bicuspid valves are

It is caused by an abnormal or inadequate fusion represented by one valve common to both
of the superior and inferior endocardial cushions sides of the heart.
with the mid portion of the atrial septum and the • Two common hemodynamic abnormalities
muscular portion of the ventricular septum. are found:
a. LR shunt of blood from the left atrium to
the right atrium causing an enlarged right atrium
and right ventricle
b. Mitral valve regurgitation causing an enlarged
left atrium and left ventricle
Tricuspid atresia : • complete agenesis of the tricuspid valve so
• is caused by an that no communication between the right
insufficient amount of AV atrium and right ventricle exists.
cushion tissue available • It is associated clinically with marked
for the formation of the cyanosis and is always accompanied by the
tricuspid valve. following:
a. Patent foramen ovale
b. Interventricular septum defect
c. Overdeveloped left ventricle
d. Underdeveloped right ventricle

VSD Membranous VSD:

is a defect in the ventricular septum, the wall • This is the most common type of VSD.
dividing the left and right ventricles of the heart. • is caused by faulty fusion of the right
3 types: bulbar ridge, left bulbar ridge, and AV
• Membranous VSD cushions.
• Muscular VSD • A large VSD is initially associated with a
• Common ventricle L R shunting of blood, increased pulmonary
blood flow, and pulmonary hypertension.

. Persistent truncus arteriosus (PTA) :
• is caused by abnormal neural crest cell
migration such that there is only partial
development of the AP septum.
- The trunchus arteriosus fails to divide the
aorta and the pulmonary arteries
• pulmonary resistance may become higher
than systemic resistance and cause
RL shunting of blood and cyanosis.
• At this stage, the characteristic of the
patient has been termed the Eisenmenger
complex.
Muscular VSD:
• is caused by single or multiple
perforations in the muscular IV septum.
• Muscular VSDs, representing 20% of
isolated VSDs, are completely surrounded
by muscle.
•  Muscular VSDs can be multiple, and
have been described as having a "swiss-
cheese" appearance.
Symptoms
• Patients with ventricular septal defects
may not have symptoms.
The most common symptoms include:
• A bluish tint to the skin, lips and fingernails
(cyanosis)
• Poor eating, failure to thrive
• Fast breathing or breathlessness or SOB
• Easy tiring
• Swelling of legs, feet or abdomen
• Rapid heart rate
Clinical manifestations:
• Cyanosis presents at birth
• Heart failure occurs within weeks
• Systolic ejection murmur is heard at the
left sternal border
• Widened pulse pressure
• Bounding arterial pulses
• Loud second heart sound
• Cardiomegaly
• Increased pulmonary vascularity
• PTA is usually accompanied by a
membranous VSD and is associated
clinically with marked cyanosis (R to L
shunting of blood).
Tetralogy of Fallot (TOF):
• is caused by an abnormal neural crest cell
migration such that there is skewed
development of the AP septum.
• TOF results in a condition in which the
pulmonary trunk obtains a small diameter,
whereas the aorta obtains a large
diameter.
TOF is characterized by four classic malformations:
pulmonary stenosis most important
right ventricular hypertrophy,
overriding aorta
ventricular septal defect (VSD)
Transposition of the great arteries:
• is caused by abnormal neural crest cell
migration such that there is nonspiral
development of the AP septum.
Transposition results in a condition in which the
aorta arises abnormally from the right ventricle
and the pulmonary trunk arises abnormally from
the left ventricle
Typical signs and symptoms may include:
• Cyanosis presents at birth (A bluish
coloration of the skin caused by blood low
in oxygen)
• Shortness of breath and rapid breathing
• Loss of consciousness (fainting)
• Clubbing of fingers and toes (an abnormal,
rounded shape of the nail bed)
• Lack of appetite
• Poor weight gain
• Tiring easily during play
• Irritability
• Tet spells
Infrequently, babies with tetralogy of
Fallot will suddenly develop deep blue
skin, nails and lips after crying, feeding or
upon awakening. These episodes are
called "Tet spells" and result from a rapid
drop in the amount of oxygen in the blood.
• Toddlers or older children may
instinctively squat when they are short of
breath.
• Squatting increases blood flow to the
lungs.
• Blue color of the skin (cyanosis)
• marked cyanosis at birth (R--- L
shunting of blood).
• Shortness of breath
• Lack of appetite
• Poor weight gain
incompatible with life unless an accompanying
shunt exists like a VSD, patent foramen ovale, PDA