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Posts Tagged ‘ostium secundum asd’

Spontaneous closure of VSD is  a well recognised  phenomenon, than ASD  though both happen in equal frequency.The simple reason being VSD is a noisy disease , ironically the smaller the size of VSD  more noisy it is . Hence  it is rarely  missed  while ASD is largely silent in children. For this reason  it is  possible ASD may be the most common congenital disease .

Natural history of ASD(OS) closure

  • ASDs of size 3-4 mm 100 % will close by 3  years
  • Bulk of the ASD < 8  mm close spontaneously by 5 years.
  • ASD> 10mm is unlikely to close

Factors that determine spontaneous closure

  • Apart from size and location
  • Closure  is accelerated by remnant of flap of foramen  ovale
  • Fenestrations and  Septal  aneurysms also  favor spontaneous closure.
  • Margins  of the defect if rough  triggers fibrotic reactions

spontaneous closure of asd

Why SVC and primum defect do not close easily ?

Plane of ASD  secundum is single and  bridging of tissue is possible .

Sinus venous and  primum defects exhibit  holes which run in multiple planes hence approximation not possible . They also do not  have a valve mechanism.

Un-natural history of ASD

In the current era, one more  force interferes  with spontaneous closure of ASD . It  comes from the  hyper trained aggressive Interventional cardiologists who compete with the nature and easily prevail over it !

Reference

asd spontaneous closure

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This is a relatively common abnormality of IAS. It is  often observed  as  IAS bulging  into left  or right atrium  in routine echocardiogram.If this happens without  atrial hypertension it is termed as IAS aneurysm .

This is due to valve of foramen ovale bending into the RA/LA*  cavity for various distance. By definition , the radius of curvature of  the bulge should be more than 10 mm to label it as IAS aneurysm.

*Bulging into RA more common

Click on the Image to see the animation

General features

  • Mostly a benign entity.
  • More often observed  in  association with PFOs or ostium secundum ASD.
  • When occurs in isolation does not result in any shunting across it
  • The septal bulge can be static or  dynamic . It could swing  into LA, RA, and back to LA or vice versa.
  • Anatomically 5 types are proposed.
  • Multiple fenestration in the aneurysms have been noted.
  • Aneurysm  formation may aid in spontaneous closure of ASD.

Clinical  implications

  • IAS aneurysm tend to aggravate  stasis of LA  blood flow and predispose to minute LA clots and systemic thrombo embolism .
  • IAS aneurysm can act as an arrhythmic focus , generating focal atrial tachycardias.
  • A non ejection click  may be occasionally heard as  the IAS aneurysm  bulges and tenses within LA/RA cavity .

Reference


1 . Olivares -Reyes A, et al. Atrial Septal Aneurysm: A new classification in 205 adults. J Am Soc Echocardiogr
1997;10:644-56.

2. Longhini C, et al. Atrial septal aneurysm: echocardiographic study. Am J Cardiol 1985;56:653-67.

3. Gondi B, Nanda NC. Two-dimensional echocardiographic features of atrial septal aneurysm. Circulation 1981;63:452-57

4. http://www.fac.org.ar/revista/00v29n4/congreso/premio3.PDF

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