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LEFT TO RIGHT SHUNT LESIONS

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  1. extra blood is displaced through a communication from the left to the right side of the heart, resulting in increased pulmonary blood flow
  2. shunt volume dependent upon three factors: size of defect, pressure gradient between chambers or vessels, peripheral outflow resistance
  3. untreated shunts can result in pulmonary vascular disease, RVH, and R to L shunts


Atrial Septal Defect (ASD) 

 

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  1. Three types
    • ostium primum - common in Down syndrome
    • ostium secundum - most common type (50-70%)
    • sinus venosus - defect located at entry of SVC into right atrium 
  2. often asymptomatic in childhood
  3. Murmur:
    • often grade 3-3/6 pulmonic outflow murmur with widely split and fixed S2
  4. ECG: RAD, mild RVH, RBBB
  5. CXR:  increased pulmonary vasculature
  6. Natural history:  80-100% spontaneous closure rate if ASD diameter < 8 mm
  7. if remains patent, CHF and pulmonary HTN can develop in adult life
  8. Management:  elective surgical or catheter closure (low risk procedures) between 2-5 years of age

 

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Ventricular Septal Defect (VSD) 

 

 

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  1. most common congenital heart defect (30-50%)

 

Small VSD (majority) (smaller than aortic valve,<3mm)

  1. asymptomatic, normal growth and development
  2. Murmur: early systolic to holosystolic, best heard at LLSB
  3. ECG and CXR are normal
  4. most close spontaneously, does not need surgical closure even if remains patent

Moderate to Large VSD

  1. Delayed growth and development, decreased exercise tolerance, recurrent URTIs or "asthma" episodes, CHF
  2. Murmur: holosystolic at LLSB with thrill, mid-diastolic rumble at apex
  3. ECG: LVH, LAH, RVH
  4. CXR:  increased pulmonary vasculature, cardiomegaly, CHF
  5. Natural history:  secondary pulmonary HTN, CHF by 2 months of age
  6. Management:  treatment of CHF; surgical closure

 

Patent Ductus Arteriosus (PDA)

 

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  1. patent vessel between descending aorta and pulmonary artery
  2. 5-10% of all congenital heart defects
  3. common in premature infants (1/3 of infants < 1750 grams)
  4. may be asymptomatic or have apneic or bradycardic spells, exertional dyspnea
  5. associated tachycardia, bounding pulses, hyperactive precordium,wide pulse pressure
  6. Murmur: continuous "machinery" murmur, best heard at left infraclavicular area 
  7. ECG: may show LVH, RVH
  8. CXR:  normal to mildly enlarged heart, increased pulmonary vasculature
  9. Diagnosis by echocardiography
  10. Natural history: spontaneous closure common in premature infants,
    less common in term infants
  11. Management: indomethacin, surgical ligation, or catheter closure
  12. high risk of SBE, antibiotic prophylaxis required until 6 months after closure

Endocardial Cushion Defect

 

  1. spectrum from endocardial cushion VSD and ostium primum ASD to
    complete AV canal with common AV valve
  2. commonly associated with Down syndrome
  3. natural history depends on size of defect and valvular involvement
  4. complete AV canal require early complete surgical repair, preferably
    before 3 months of age
LEFT TO RIGHT SHUNT LESIONS LEFT TO RIGHT SHUNT LESIONS Reviewed by Radiology Madeeasy on August 28, 2010 Rating: 5
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