Page 159 - Clinical Pearls in Cardiology

Congenital Heart Disease 147

flow across the pulmonary valve and tricuspid valve
respectively. Ostium primum ASD may be associated
with endocardial cushion defects, resulting in mitral or
tricuspid regurgitation.
11. Which are the syndromes commonly associated with
atrial septal defect?
A number of syndromes are associated with atrial septal
defect. They are the following:
• Lutembacher’s syndrome—is a combination of
congenital ASD and acquired MS.
• Holt-Oram syndrome—is a combination of absent
radial bones, atrial septal defect and first degree heart
block.
• Fetal alcohol syndrome—is usually associated with
an ASD or VSD.
• Down’s syndrome—is usually associated with ostium
primum ASD.

12. When do you contemplate surgical intervention in
ASD or VSD?
Surgical intervention or device closure to repair
the septal defect is contemplated if the patient is
symptomatic or when the ratio of pulmonary blood
flow to systemic blood flow is more than or equal to 1.5.
Severe pulmonary hypertension and shunt reversal are
both contraindications to surgical intervention.
13. What is the difference between a to and fro murmur
and a continuous murmur?
In the case of a to-and-fro murmur, the systolic
component is due to the flow of blood in one direction
and the diastolic component is due to the flow of blood
in the opposite direction (as in combined aortic stenosis
and aortic regurgitation). A continuous murmur is due