ventricular septal defects

type of left to right shunt
= 30% of all congenital heart disease cases
defect anywhere in ventricular septum
1. perimembranous
  1. i.e. adj to tricuspid valve
2. muscular
  1. i.e. completely surrounded by mm
typed according to size
1. small VSDs
  1. smaller than aortic valve diameter
    1. i.e. up to 3mm
  2. clinical features
    1. symptoms
      1. asymptomatic
    2. signs
      1. loud pansystolic murmur @ lower left sternal edge
        loud murmur implies smaller defect
      2. quiet pulmonary second sound P2
  3. Ix
    1. CXR
      1. normal
    2. ECG
      1. normal
      2. inverted T wave
        means no pulmonary HTN
    3. Echo
      1. shows anatomy of defect
      2. Doppler echo- shows haemodynamic effects of VSD
      3. no pulmonary HTN
  4. Mx
    1. close spontaneously
      1. murmur will disappear
      2. normal ECG on follow up
      3. normal echo
    2. maintain good dental hygiene while VSD present
      1. prevent bacterial endocarditis
2. large VSDs
  1. defects same size or bigger than aortic valve
  2. clinical features
    1. symptoms
      1. after 1 week old
        heart failure
        breathlessness
        failure to thrive
      2. recurrent chest infections
    2. physical signs
      1. of heart failure
        tachypnoea
        tachycardia
        hepatomegaly
      2. active precordium
      3. soft pansystolic murmur or no murmur
        implies large defect present
    3. apical mid-diastolic murmur
      1. from increased flow across mitral valve after blood has circulated through the lungs
    4. loud pulmonary 2nd sound (P2)
      1. from raised pulmonary arterial Pa
  3. Ix
    1. CXR
      1. cardiomegaly
      2. enlarged pulmonary aa
      3. increased pulmonary vascular markings
      4. pulmonary oedema
    2. ECG
      1. biventricular hypertrophy by 2 months of age
      2. upright T wave
        indicates pulmonary HTN
    3. Echo
      1. show anatomy of defect, haemodynamic effects & pul HTN (due to high lfow)
  4. Mx
    1. heart failure
      1. diuretics
      2. captopril
    2. additional calorie input
    3. surgery @ 3-6 months
      1. aims
        manage heart failure & failure to thrive
        prevent lung damage from pulmonary HTN & high blood flow
        kids w/ large VSD & L to R shunt always have HTN
        -> irreversible damage to pulmonary vasc capillary bed

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ventricular septal defects

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	Created by v.djabatey about 10 years ago