Atrial Septal Defect Simple and Complex

Galen knew of the foramen ovale and its normal postnatal closure.123 Leonardo da Vinci wrote, I have found from left auricle to right auricle the perforating channel, and his subsequent account a true atrial septal defect is believed to be the first record of a congenital malformation of the human heart.145 Botallo described a persistent foramen ovale after birth but without understanding its function in the fetus.123 Gassendi composed an entire treatise based on observations of a patent...

Physical Appearance

Patients with cyanotic Fallot's tetralogy are as a rule physically underdeveloped.15,184 Excessive collateral arterial blood flow accompanying pulmonary atresia can cause congestive heart failure and poor physical development in infants. Cyanosis in Fallot's tetralogy varies from absent to severe and is symmetrically distributed.John Hunter described such a patient I was consulted about a young gentleman's health. From his infancy, every considerable exertion produced a seeming tendency to...

The Arterial Pulse

Moderately restrictive defects with relatively low pulmonary vascular resistance are associated with a brisk arterial pulse because of vigorous ejection from a volume loaded left ventricle. Nonrestrictive defects with large left-to-right shunts and congestive heart failure are associated with a diminished arterial pulse and pulsus alternans. The arterial pulse in Eisenmenger syndrome is normal because systemic stroke volume is maintained (Fig. 17-12).248 Photograph of the chest of an 8-year-old...

Auscultation

The physiology of Fallot's tetralogy is nicely reflected in the accompanying auscultatory signs. Ejection sounds originate in a dilated aorta (see Figs. 18-6A and 18-7A) and are therefore important auscultatory signs of severe pulmonary stenosis or pulmonary atresia (Fig. 18-19 (see Figs. 18-21 and 18-23 thru 18-25).133'136'211'212 The aortic ejection sound is maximum at the upper right sternal border but when loud' is heard along the left sternal border and toward the apex. The ejection sound...

References

In Nelson's Loose Leaf Medicine, vol 5. New York, Thomas Nelson and Sons, 1932. 2. Agustsson MH, Arcilla RA, Bicoff JP, et al Spontaneous functional closure of ventricular septal defects in 14 children demonstrated by serial cardiac catheterizations and angiocardiography. Pediatrics 31 958, 1963. 3. Albers HJ, Carroll SE, Coles JC Spontaneous closure of a membranous ventricular septal defect. Necropsy finding with clinical application. Br Med J 2 1162, 1962....

Congenital Pulmonary Arteriovenous Fistula

In 1897, Churton described the necropsy findings of congenital pulmonary arteriovenous fistulae in a 12-year-old boy.31 Four decades later, the anomaly was recognized in a living subject.113 Pulmonary arteriovenous fistulae are the result of a developmental fault in the vascular complex that is responsible for pulmonary arteries and veins.6'84 The fis-tulae can be solitary or multiple, unilateral or bilateral, or minute and diffuse throughout both lungs.* Approximately 75 of congenital...

Coarctation of the Aorta

Aortic Tubular Hypoplasia

In 1760, the Prussian anatomist Johann Friedreich Meckel characterized coarctation of the aorta as an extraordinary dilatation of the heart which came from the fact that the aortic conduit was too narrow.104Jarcho's informative historical papers underscored the clarity of early accounts of this congenital malformation.103-107 Coarctation of the aorta is typically located near the aortic attachment of the ligamentum arteriosum or patent ductus arteriosus (Figs. 8-1A and 8-2). An obtuse...

The Jugular Venous Pulse

The jugular venous pulse is elevated under two widely divergent physiologic circumstances. The first and most Physical appearance of a 15-month-old boy with complete transposition of the great arteries. Birth weight was 9 pounds 2 ounces. The child's head is large, although his body and arms have lost the robust appearance with which he was born. Physical appearance of a 15-month-old boy with complete transposition of the great arteries. Birth weight was 9 pounds 2 ounces. The child's head is...

The History

Situs Psychosis

Situs inversus with dextrocardia and a structurally normal heart is usually discovered by chance in a chest x-ray which is often considered normal because the film is inadvertently reversed when first read. There is a reported tendency for left handedness in complete situs inversus,22 but Matthew Baillie wrote The person seems to have used his right hand in preference to his left . . . which was readily discovered by the greater bulk and hardness of that hand as well as the greater fleshiness...

C

A, Illustrations of the various types of aortic valve stenosis. Illustrations on the left represent three types of congenitally abnormal aortic valves. The upper drawing shows a unicuspid acommissural valve. The middle drawing shows a unicuspid unicommissural valve with an eccentric orifice. The lower group of four drawings shows a functionally normal bicuspid aortic valve (upper center), a fibrocalcific stenotic bicuspid aortic valve (right), a bicuspid aortic valve that is inherently stenotic...

Coarctation Emotion

Coarctation of the aorta will not be overlooked if attention is paid to the upper and lower extremity arterial pulses and blood pressure during routine physical examination. The diagnosis is entertained in patients with systemic hypertension and reduced or absent femoral pulses. Disproportionate systolic hypertension heightens suspicion. Minor symptoms include headache, epistaxis, and leg fatigue. Major complications include congestive heart failure, especially in infants, rupture or dissection...

Congenital Aortic Regurgitation

Aorta Fistula

The classic features of chronic severe aortic regurgitation have been familiar to clinicians since Corrigan's treatise in 1832 On Permanent Patency of the Mouth of the Aorta, or Inadequacy of the Aortic Valves.37 The remainder of this chapter deals with pure congenital aortic regurgitation when the regurgitant flow is through an incompetent aortic valve directly into the left ventricle (Tables 7-2 and 7-3). Regurgitant flow that reaches the left ventricle through channels other than the aortic...

Goose Neck Deformity

A large left-to-right shunt is established shortly after birth when total anomalous pulmonary venous connection is accompanied by a nonrestrictive atrial septal defect, low pulmonary vascular resistance, and no obstruction. Dyspnea, cardiac failure, and physical underdevelopment begin shortly thereafter, and the majority of infants do not reach their first birthday. The clinical picture subsequently resembles a nonrestrictive ostium secundum atrial septal defect with the notable exception of...

Summary

Ostium secundum atrial septal defects predominate in females and often come to light in asymptomatic children *See references 13, 39, 56, 58, 96, 121, 131, 216, 331, 353, 390. or young adults. Patients usually reach their fourth decade with little or no handicap. Preadolescents sometimes appear delicate and gracile. Dyspnea, fatigue, and recurrent lower respiratory infections are common. The left-to-right shunt in older adults is augmented by ischemic heart disease, systemic hypertension, and...

Percussion and Palpation

A right anterior chest bulge with asymmetry arouses suspicion of dextrocardia. Percussion and palpation are useful in the clinical recognition of cardiac malpositions because these physical signs are influenced by the malposition per se, and establish the right or left thoracic location of the heart and the abdominal location of hepatic dullness and gastric tympany. If the stomach is not sufficiently air-filled to generate a tympanitic percussion note, a carbonated beverage or deliberate...

Patent Ductus Arteriosus

In 1593, Giambattista Carcano described the ductus arteriosus in his book on the great cardiac vessels of the fetus.39 However, Leo Bottali came to be associated with the arterial duct even though Bottali had misapplied the term ductus to the foramen ovale.39 It was not until Rokitansky's handbook of 1844 followed by his beautifully illustrated monograph of 1852 that patent ductus arteriosus was recognized as a specific congenital malformation.133 The incidence of isolated persistent patency of...