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- Septal defects are sometimes called a "hole" in
the heart. A defect between the heart's two upper
chambers (the atria) is called an atrial septal defect
(ASD).
- the large defect between the atria, causes a large
amount of oxygen-
oxygen-rich (red) blood leaks from the
heart's left side back to the right side; this blood is
pumped back to the lungs, despite already having
been refreshed with oxygen.
- this is inefficient, because already
already--oxygenated
blood displaces blood that needs oxygen. Many
people with this defect have few, if any, symptoms.
- atrial septal defect is an abnormal
communication between the two atria,
allowing blood to shift from the left to the
right atrium (an acyanotic defect) because of
the stronger contraction of the left side of the
heart.
- this causes an increase in the volume in
the right side of the heart and generally results
in ventricular hypertrophy and increased
pulmonary artery blood flow
-fourth to the sixth week of gestation,
the common atrium is divided into two
chambers.
- the space between these two structures
is called the ›  (first hole); as
the first septum continues to grow, a hole
called the ›   
 (second hole)
appears in its center, eventually it forms the
› 
› 
 Oncidence

- the ratio of atrial septal defect is 1:3; male


to female ratio
- it accounts 9.7% of the congenital heart
diseases or defects
 Altered Hemodynamics
- because left atrial pressure slightly
exceeds right atrial pressure, blood flows from
the left atrium, causing an increased flow of
oxygenated blood into the right side of the
heart
- this results to right atrial and right
ventricular hypertrophy
- pulmonary vascular changes usually
occur only after several decades if the defect is
unrepaired
 2linical Manifestations

- characteristic crescendo
crescendo--decresendo
(harsh) type of systolic murmur over the
second to third intercostal space along the left
sternal border. The murmur is caused by
increased blood flow through the normal
pulmonic valve, not by the blood flow across
the defect
 Assessment and Diagnosis
*physical examination
- the most suggestive sign of atrial
septal defect is its characteristic murmur

*echocardiography
- echocardiography with color flow
Doppler will generally reveal the enlarged side
of the heart and the increased pulmonary
circulation.
*cardiac catheterization
- cardiac catheterization would reveal
the separation in the atrial septum and the
increased oxygen saturation in the right atrium.

*radiography
- Radiographic findings include right atrial
and ventricular hypertrophy.
 Therapeutic Management
- surgical closure of atrial septal defect is reserved
for moderate to large shunts and is done electively
between 1and 3 years of life. Ot is particularly important
that atrial septal defect be repaired in girls, because it
can cause emboli during pregnancy.
*open heart surgery
- a cardiopulmonary bypass is done, and the
edges of the opening are approximated and sutured.
- the surgery requires the use of
extracorporeal circulation
- if the defect is large, a Silastic or Dacron
patch may be sutured into place to occlude the space
- postoperative complication is unusual, and
survival is greater than 99%.
*interventional cardiac catheterization
- closure of an atrial septal defect
using cardiac catheterization with the use of
umbrella tipped catheter.
 Nursing
ursing 2onsiderations

- pre
pre--operative preparations
- ensure aseptic technique in the surgical
and invasive management
- post
post--operatively, carefully carefully
observe the child for arrhythmias in case
edema of the right atrium interferes with SA
node function, which ,may require pacemaker
implantation.
Thank You«

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