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persistent ostium secundum
Epidemiology: most common form of atrial septal defect
Pathology:
- congenital defect at fossa ovalis
- atrial septal defect
- mitral regurgitation as late complication
Clinical manifestations:
1) may be asymptomatic
2) dyspnea
3) right ventricular precordial thrust
4) systolic ejection murmur 2nd & 3rd intercostal space
- never more than grade III/VI
5) fixed & wide splitting of 2nd heart sound S2
6) short diastolic murmur along left sternal border
7) atrial fibrillation often develops in patients in the sixth decade of life
8) may present with a neurological event
Special laboratory:
1) electrocardiogram:
a) right axis deviation [3]*
b) first degree AV block
c) late R' in right-sided leads
d) right bundle branch block is generally present
3) right atrial enlargement
2) echocardiogram:
a) 2-dimensional with doppler
1] generally shows defect
2] right ventricular enlargement
3] volume overload
b) transesophageal echocardiography may be necessary
3) cardiac catheterization generally unnecessary
* distinguishing feature from persistent ostium primum
Radiology:
chest X-ray
1) enlargement of right ventricle
2) enlargement of right atrium
3) enlargement of pulmonary artery
- increased pulmonary vascularity
4) if chest x-ray (or EKG) shows left atrial enlargement, consider persistent ostium primum with mitral regurgitation
Complications:
- right ventricular hypertrophy
- right atrial enlargement
- atrial fibrillation
- pulmonary hypertension (rare)
Management:
1) percutaneous device closure preferred [3]
- see atrial septal defect for indications & contraindications
2) antibiotic prophylaxis for endocarditis
a) not needed prior to closure
b) required for 6 months after closure only [3]
Related
ostium secundum (interatrial foramen secundum)
General
atrial septal defect (ASD)
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 868
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 45-46
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16,
17, 18. American College of Physicians, Philadelphia 1998, 2006,
2012, 2015, 2018