Agassi S. Prtama Venita N A

Radiology dept.Rumah Sakit Umum Daerah Al-Ihsan

Atrial Septal Defect

Atrial Septal Defect

• Atrial septal defect (ASD) is a form of congenital heart defect that enables blood flow between the left and right atria via the interatrial septum.

• The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart

Types of Atrial Septal Defect

There are three major types of ASD:

• Secundum• Primum• Sinus venouses

Types of Atrial Septal Defect

• Secundum. This defect is in the middle of the atrial septum. It's the most common form of ASD. About 8 out of every 10 babies born with ASD have secundum defects. At least half of all secundum ASD close on their own. This is less likely if the defect is large.

Types of Atrial Septal Defect• Primum. This defect is in the

lower part of the atrial septum. It often occurs along with abnormalities in the heart valves that connect the upper and lower heart chambers. Primum defects aren't very common. This type of defect doesn't close on its own.

• Sinus venosus. This defect is in the upper part of the atrial septum, near where the superior vena cava brings oxygen-poor blood from the upper body to the right atrium. Sinus venosus is a rare defect. Sinus venosus defects don't close on their own.

Atrial Septal Defect

Chest radiographs usually reveal the following findings:• Enlargement of the right atrium and ventricle may be

demonstrated.• Dilatation of the pulmonary artery and its branches may

be demonstrated.• Increased pulmonary vascular markings may be

demonstrated. In general pulmonary arterial overcirculation is almost always noted.

• The vascular pedicle (ascending aorta and arch and SVC shadow) is small.

• Left atrial dilatation is extremely rare (the left atrium is decompressed by the ASD) but may be observed when significant mitral regurgitation exists. The left ventricle is normal.

Kegagalan pembentukan

septum

Aliran ke atrium kanan

bertambah

Beban kerja atrium dan ventrikel

kanan bertambah

Pembesaran atrium dan ventrikel

kanan

Pembesaran jantung kanan

Apex jantung naik

Pelebaran batas kanan

jantung

Pinggang jantung

menghilang

Retrosternal space terisi

Pelebaran arteri

pulmonalis

Penebalan tunika intima

arteri pulmonalis

periferReverse Coma

appearance

Hipertensi pulmonal

Peningkatan tekanan

ventrikel kanan

Eisenmenger Syndrome

Kebocoran bidirectionalSianosis Pembesaran

atrium kiri

Manifestasi Klinis Atrial Septal Defect

• Gejalanya bisa berupa: - sering mengalami infeksi saluran pernafasan - dispneu (kesulitan dalam bernafas) - sesak nafas ketika melakukan aktivitas - jantung berdebar-debar (palpitasi).

Atrial Septal Defect

• The main pulmonary artery (MPA) is grossly dilated.

• The right pulmonary artery (RPA) is also quite enlarged.

• Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine.

• Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen.

• Apex is upwards, suggesting a right ventricular enlargement.

Atrial Septal Defect

• In severe cases the right ventricle is dilated, this will be manifested by fullness of the anterior border of the heart in the lateral views resulting in obliteration of lung tissue normally noted in between the heart and sternum.

Atrial Septal Defect

• C.) large atrial septal defect (2 × 2.5 cm) (black arrow) with left-to-right shunt visible on the

velocity - encoded image (white arrow) and enlarged right-sided chambers

Prognosis• Biasanya ASD dapat ditoleransi dengan

baik pada bayi maupun pada anak. Untuk ASD dengan shunt yang besar, operasi segera dipikirkan, guna mencegah terjadinya hipertensi pulmonal. Hipertensi pulmonal pada ASD jarang sekali terjadi pada anak. Umur harapan penderita ASD sangat tergantung pada besarnya shunt. Bila shunt kecil dan tekanan darah pada ventrikel kanan normal operasi tedak perlu dilakukan.