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Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The aetiology of ASDs is not known, but they are associated with several syndromes such as Holt–Oram; dominant inheritance of ASDs in some families is well recognised. ASD is an acyanotic defect of abnormal communication across the atrial septum with left to right shunting. The defect may occur at different positions in the atrial septum, most commonly in the ostium secundum (70%) at the position of the fossa ovalis after incomplete development of the septum secundum (Figs 5.10, 5.11). Ostium primum defects (~25% of ASDs) occur at the lower part of the atrial septum when the septum primum fails to extend to the endocardial cushions. Sinus venosus defects (5% of ASDs) are located at the top of the atrial septum after failure of absorption of the sinus venosus into the right atrium, the right upper lobe pulmonary vein then often draining into the lower part of the superior vena cava (partial anomalous pulmonary venous drainage).
Interventions for congenital heart disease
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Atrial septal defects may occur in the region of the foramen ovale (ostium secundum defects), at the junction of the superior vena cava and right atrium (sinus venosus defects), or as part of an endocardial cushion defect (ostium primum defect). The ostium secundum atrial septal defect (ASD) is the most common congenital defect encountered in adults. It accounts for approximately 7% of all congenital heart disease and for 30%–40% of all patients presenting with a congenital defect in adult life. ASDs occur more frequently in women than in men, with a female to male ratio of 1.5–2.0:1.1 They can be multiple and can be associated with excessive mobility of the surrounding septum. Sinus venosus defects are commonly associated with anomalous drainage of the right upper and lower pulmonary veins into the right atrium. Ostium primum defects are usually associated with other developmental defects of the endocardial cushion (the fibrous structure that forms the tricuspid and mitral valve annuli), such as a cleft mitral valve and a membranous ventricular septal defect. Ostium primum and sinus venosus defects are not suitable for percutaneous closure since the accompanying abnormalities usually require surgical correction.
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In ostium primum ASD, the anomaly is a form of partial atrioventricular canal defect or endocardial cushion defect. The abnormalities are confined to the atrial septum and are caused by the endocardial cushions failing to develop and so close the ostium primum part of the interatrial septum. The defect is associated with abnormalities of the mitral valve, leading to mitral regurgitation. There is a relatively high incidence of this abnormality in trisomy 21 (Down syndrome). Typically, the primum defect presents earlier than ostium secundum in childhood, with dyspnoea, recurrent chest infections and, if pulmonary hypertension develops, cyanosis.
Current practice in atrial septal defect occlusion in children and adults
Published in Expert Review of Cardiovascular Therapy, 2020
Wail Alkashkari, Saad Albugami, Ziyad M. Hijazi
ASDs are the third most common type of CHD with an estimated incidence of 56 per 100,000 live births [1]. By definition, an ASD is a direct communication between the atrial cavities that allow shunting of blood. There are four types of ASD, including primum, secundum, sinus venosus (SV), and coronary sinus (CS) defects. Secundum ASD is located in the region of the fossa ovalis and considered a true defect of the atrial septum. The other three types of ASD represent interatrial communications that are located outside the area of the true atrial septum. Primum ASD represents persistence of the embryonic ostium primum, and in many cases, the oval fossa is well formed and intact. SV defects are located outside the confines of the true septum, superiorly or inferiorly and referred to as superior and inferior SV defects, respectively. The superior SV defect allows the orifice of the superior vena cava (SVC) to override the septum and drain into both atrial chambers and commonly associated with partial anomalous connection of the right superior pulmonary vein to the SVC. The inferior SV defect is similar to the superior type but related to the orifice of the inferior vena cava (IVC) and not uncommonly associated with partial anomalous connection of the right inferior pulmonary vein to the IVC. CS defects represent many morphologic variations of defects that allow interatrial communication. They are holes at the site of the CS orifice that allow direct interatrial communication or are located on the postero-inferior wall of the left atrium (LA) allowing passage of blood between the LA and the CS channel [2]. Secundum ASD accounts for 65% to 75% of all ASDs. Females compose 65% to 75% of patients with secundum ASD, but the sex distribution is equal for the other type of ASD [3].
Patent foramen ovale and cryptogenic stroke: contemporary evidence and treatment
Published in Expert Review of Cardiovascular Therapy, 2018
J. J. Coughlan, Aidan Daly, Samer Arnous, Tom J. Kiernan
As the septum primum grows toward, and ultimately fuses with, the endocardial cushion, the ostium primum is obliterated. However, multiple small perforations develop in this septum primum. These perforations coalesce at the cephalic part of the septum primum and form a second orifice, known as the ostium secundum. The ostium secundum allows free flow of blood from the right to the left atrium.