Atrial septal defect

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ASD causes increased pulmonary arterial flow due to blood being shunted from the left to the right atrium and, subsequently, through the pulmonary arteries and veins. This overcirculation causes pulmonary plethora making the vessels appear distended. The right atrium, right ventricle, pulmonary artery and veins become enlarged. The vessels appear crisper than pulmonary venous hypertension (due to lack of oedema) and upper lobe distension is absent. After time persistent overcirculation through the pulmonary arteries results in increased pulmonary resistance and rapid tapering of the pulmonary arteries - pruning. Reversal of the shunt can occur with time - Eisenmenger reaction. Calcification may develop in the pulmonary arteries in cases of chronic pulmonary hypertension (Table 1.6).

Table 1.6 Causes of pulmonary hypertension

■ Chronic pulmonary venous hypertension, e.g. mitral valve disease

■ Congenital heart disease with left to right shunts

■ Pulmonary emboli

■ Primary pulmonary arterial hypertension

■ Chronic lung disease

Pulmonary Arteryenlargement
Fig. 1.42 Patent ductus arteriosus (PDA), is a cause of pulmonary hypertension - note the pulmonary artery enlargement. A metallic coil has been placed to occlude the ductus arteriosus.
Pulmonary ArteryenlargementPulmonary Arteryenlargement

71-year-old male. Sudden onset of severe, tearing chest pain.

Fig. 1.44 Quiz case.

71-year-old male. Sudden onset of severe, tearing chest pain.

Fig. 1.44 Quiz case.

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