Saturday, November 13, 2010

Atrioventricular septal defect

Atrioventricular Septal Defect (AVSD)
    A defect in the atrial and ventricular wall and various degress of atrioventricular valve regurgitation due to deficiency of endocardial cushion tissue.

1 - atrial septal defect
2 - abnormal tricuspid valve
3 - abnormal mitral valve
4 - ventricular septal defect
The shunt or abnormal flow is from left atrium to
right atrium, left ventricle to right ventricle
(as indicated by the shaded red arrows). Tricuspid
and mitral valve regurgitation occurs as a result
of the abnormal tricuspid and mitral valves

Acyanotic defect...usually left to right shunts as blood is shunted from areas of high to low resistance. This causes pulmonary overcirculation and frequently CHF results.

Characterized by a large atrial and ventricular septal defects and a common atrioventricular valve.

Usually results in a net left to right shunt once PVR decreases and causes pulmonary overcirculation.

Often associated with Down's syndrome.

Symptoms of CHF and pulmonary overcirculation usually occur early in infancy.

A normal oxygen saturation is usually present unless a V/Q mismatch from pulmonary changes from a large left to right shunt are present.

Systolic ejection murmur at left sternal border.

CXR shows an enlarged heart.

IV, O2, Monitor

3cc/kg/hr D10W  for infants under 1 year of age, D5W if over 1 year.

Management of CHF, consider Lasix.

Pulmonary hypertensive crisis (rapid fall in BP and heart rate with concomitant rise in PAP to systemic levels or higher) is treated with hyperventilation, hyperoxygenation, pulmonary vasodilators, sedation, and paralysis.

Foley catheter insertion to follow renal perfusion and urine output.

ABG to follow acidosis.

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