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Disease
Esti Hindariati
Consultant Cardiologist
Over a million adult survivors
of congenital heart disease
Develop symptoms
TEE
(sinus venosus ASD & specifically measure the
size of any ASD)
Presence & type of defect
Exact defect size
Distance of defect rims (TEE)
Quality of atrial septal margins
around the defect (TEE)
Right ventricular size
Qp / Qs
Pulmonary atery pressure
Any aother associated congenital
anomalies
Entry of pulmonary veins
Cardiac MRI
Often used when the diagnosis is unclear after
echo studies
Catheterizati
on
Surgical Catheter-Based
Closure Closure
(Appropriately-sized ostium
Endocarditis prophylaxis
secundum ASD)is not
ASD Closure Indicated:
Qp : Qs shunt ratio > 1.5 : 1.0
Evidence of dilatation of the right
heart chambers (RV volume overload)
Symptoms attributed to the ASD
Contraindications to closure:
Irreversible pulmonary arterial hypertension
Poor LV function
VENTRICULAR SEPTAL
DEFECT
Types of VSD based on
anatomic location
1.Perimembranous
60-80 %
2.Inlet VSD
8%
3.Outlet VSD
5-7 %
4.Muscular
5-20 %
5.Gerbode defect
Shunt between the
LV & RA
Usually small & rare
VSD
Pathophysiology
LV volume overload
Heart Failure
It is indicated:
In the event of inconclusive results of
noninvasive assessment
To obtain a more specific finding
To assess the severity of RV outflow tract
obstruction
To exactly determine PAP & resistance
To test the response to vasodilating agents in
Treatment
Small VSD do not cause symptoms & do not
require intervention
Surgical Catheter-Based
Closure Closure
Endocarditis prophylaxis is required
PATENT DUCTUS
ARTERIOSUS
PDA
Embryologic
remnant
Connects the roof
of the pulmonary
artery to the
proximal
descending aorta
5-10 % of all CHD
Closes functionally
during the first 48
Considered abnormal if it remains widely patent beyond
hours
second weeks after birth
of life
PDA
Pathophysiology
Heart Failure
Surgical Catheter-Based
Ligation Closure
Endocarditis prophylaxis is no longer
recommended
AHA Guidelines Cardiac Conditions
For Which IE Prophylaxis is
Recommended
Prosthetic cardiac valve
Previous IE
Congenital Heart Disease (CHD)
Unrepaired cyanotic CHD, including palliative shunts &
conduits
Completely repaired congenital heart defect with
prosthetic material or device, wheter placed by surgery or
by catheter intervention, during the first 6 months after
the procedures
Repaired CHD with residual defects at the site of or
adjacent to the site of a prosthetic patch or prosthetic
device (which inhibits endothelialization
Cardiac transplantation recipients who develop cardiac
valvulopathy
Thank
You