Atrial Septic Defect

Neeraj Awasthy, Dinesh Singh Bhist
Introduction And Embryology

ASD is a congenital heart defect (CHD). CHDs are very common in children, 8 per thousand is the prevalence. ASD contributes about 15-20% of CHDs. Interatrial communication i.e Patent Foramen Ovale( PFO) is essential for fetal survival hence Fossa ovalis ASD is difficult to rule out antenatally. Although fetal echo can rule out ASD by absence of flap of the fossa ovalis.
PFO may remain patient in 25% after delivery.

Embryology:- (classic model) & type of ASD

A crescent shaped septum (septum primum) begins to form along the dorsal and cranial wall of the primitive atrium and grows towards the endocardial cushions. Then small perforations develop in the dorsal wall of septum to form ostium primum. If the endocardial cusions fail to unite to septum primum then ostium primum type of ASD is formed.
Then septum secundum migrates from right side of septum to close the ostium primum. Failure of migration of septum secondum or excess resorpition of septum primum dorsally forms fossa ovalis ASD.
The sinus venosum unites with the primitive atrium from right side to form RA. Failure to unite results in sinus venosus type of ASD (IVC, SVC, atrial type).

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