Disease
diagnosis and management
Supomo
Increased every years
At the TCCCA: 1500 cases in 1990 , and 7500
cases in 2002
In USA estimated growth 5% per years
In Sardjito Hospital about 5 cases per month
I Without previous surgery
Problems :
- RV and LV functions
- PVR may high
- Arrhythmias may present
INOTROPIC, Vasodilator,
pacemaker wire
Types : osteum secundum, sinus venousus, and coronary
sinus
Spesific problems:
1. volume and sometime pressure overload.
2. May causes exercise limitation
3. atrial fibrilation ( usually over age 30 )
4. Right heart failure ( usually over age 40 )
5. Paradoxical embolism TIA/Stroke
6. Pulmonary hypertension
A persistent opening in the interatrial septum after birth that allows
direct communication between the left and right atrium.
5% 15%
80%
<1%
<1%
1. Type of ASD
2. The size of defect
3. The functional importance of the defect :
- shunt size ( Qp/Qs)
- RV size, RA size
- Pulmonary artery pressure.
4. Identifies other associated that may influence management
( e.g. anomalous pulmonary venous connection, valve
disease, or coronary artery disease)
The initial workup :
1. Clinical assessment
2. ECG
3. Chest x-ray
4. TTE
5. TEE
6. Resting oxygen saturation
7. Heart catheterization
8. Coronary angiography
ESC. Guidelines for the management of grown-up congenital heart
Device closure( ASO) : defect size less than 36 mm
Rim : minimal 4 mm
Surgical closure :
- defect size up 36-38 mm
- sinus venosus or osteum primum types
Percutaneous closure is contraindicated if the defect is
very large, has inadequate rims
Associated with other intracardiac anomalies requiring
surgery
Stretched ASD size greater than 36 mm and native size
greater than 25 mm are contraindications for device
closure
Relative contraindications include multiple ASDs,
fenestrated septum primum, and redundant or
aneurysmal septum primum
Kouchoukos NT, Hanley FL, Kirklin JK, Blackstone EH. Cardiac surgery. 4th ed.
Median sternotomy or right thoracotomy
Cardiopulmonary bypass with hypothermia ( 30 to
32 0C
Closure of the defect ( primary or patch closure)
PA pressure monitor line.
Insert intrapericard drain.
Post operative care
Problems :
- RV and LV functions
- PVR may high
- Arrhythmias may present
INOTROPIC, Vasodilator,
pacemaker wire
Device closure :
- early and intermediate follow up is excellent
- long-term outcome unknow
- arrhythmias and thromboembolic complication ?
Surgical closure :
- For ASD without pulmonal hypertention , surgical mortality
very low ( < 1%).
- Arrhythmias may be may persist
- LV failure may be occur ( associated : CAD, hypertension,
mitral valve incompetence)
- may appear cardiac tamponade for the first several week after
surgery
May occur in up 1/3 of patient
Give anticoagulate for first 6 month post-operative
Anticoagulation may be stoped if they remain
arrhythmia free or no other risk factors
If atrial fibrilation occors anticoagulants and
antyarrhythmias therapy are indicated
Periodic follow up about :
- Pulmonary artery pressure
- Atrial arrhythmias
- ventricular dysfunction
- Pericard effusion for several month.
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