MANSHURIN STUDENT

Ventricular Septal Defect (VSD)

A hole connecting the 2 ventricles

Acyanotic

Left-Right Shunt

Causes

•          Congenital (prevalence 2:1000 births) à most common congenital cardiac malformation
•          Acquired (post-MI)

Type

1.       Membranous VSD (90%)

2.       Muscular VSD

3.       Single Ventricle

Clinical Feature

Small VSDs : asymptomatic & usually close spontaneously, with 90% no longer patent by 10 years of age

Moderate VSDs : Fatigue & SOB with cardiac enlargement & prominent apex beat.

                                 Palpable systolic thrill at lower left sternal edge & loud ‘tearing’ pansystolic murmur heard at the same position.

Large VSDs : cause pulmonary HPT (may lead to Eisenmenger’s syndromeà central cyanosis & finger clubbing)

** loud ‘tearing’ pansystolic murmur produced by flow from high pressure LV to low pressure RV during systole.It’s best heard at left sternal border.

On PE (auscultatory finding)

Small VSDs (‘maladie de Roger’) : Loud & sometimes Long Systolic Murmur

Moderate VSDs : loud ‘tearing’ pansystolic murmur

Large VSDs : cause pulomonary HPT & soft murmur

Cx

• AR
• IE
• Pulmonary HPT
•  Eisenmenger’s complex (In this condition, a ventricular septal defect (VSD) exists in conjunction with pulmonary vascular obstructive disease (PVOD). The resistance to blood flow to the lungs involved in PVOD causes a "right to left shunt" to occur, in which blood flows from the right ventricle into the left ventricle through the VSD)

Ix

§                             ECG

o   normal (small VSD)

o   LAD + LVH (moderate VSD)

o   LVH + RVH (large VSD)

§                           CXR

o   Normal heart size +- mild pulmonary plethora (small VSD)/ cardiomegaly

o   Large pulmonary arteries

o   Marked pulmonary plethora (large VSD)

Mx

1. Small VSD require no specific tx.only IE prophylaxis should be advised
2. Surgical repair of the defect
3. Cardiac failure should be treated with:

a.      Digoxin

b.      Frusemide