ASD & VSD
ASD - Overviews 2nd m/c adult congenital heart dis (20%) Type Secundum (이차공) – m/c(75%), fossa ovalis의 결손 Primum (일차공) – 15%, MV or TV cleft, small VSD 동반, 발생학적으로 partial artrioventricular septal defect로 분류 Sinus venosus (정맥동) – SVC (or IVC) 유입부의 결손, Rt upper pul vein의 anomalous drainage 동반 Coronary sinus (관정맥동) – rare, persistent Lt SVC동반
ASD - Echocardiography ASD – diameter of defect Volume overload & enlargement of Rt heart : Paradoxical septal movement Color doppler – shunt flow * 단략양 (Qp/Qs or pul a. VTI 15~20cm vs aortic a. VTI 20~ 25cm) TR, PR, MR Pul HTN * 4x(TR velocity)2 + RA Pr TEE or contrast echo
ASD – Closure of the defect Indications : development of symptoms and high rate of shunt flow * significant shunt flow Qp/Qs > 2:1 Surgical closure Percutaneous closure of secundum ASDs < 30mm diameter
VSD - Overviews Type Perimenbranous (막양부형) – m/c, 막성 중격과 그 주의의 결손, 작은 결손시 자연폐쇄과정에서 aneurysm, TR or AR동반 Subarterial (대혈관 판하형) – 동양인에서 호발, AV prolapse에 의한 AR Muscular (근성부형) – 대개 학동기 전에 자연폐쇄, acquired(MI) 그외 a: outlet defect; b: papillary muscle of the conus; c: perimembranous defect; d: marginal muscular defects; e: central muscular defects; f: inlet defect; g: apical muscular defects. Muscular septum
VSD - Echocardiography 폐동맥압 측정 - 장기예후와 관련 Rt to Lt shunt (severe pulmonary HTN or PS) RV sys pr. = SBP – 4 x (VSD velocity)2