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Ventricular Septal Defect

Ventricular septal defect (VSD) is the second most common congenital heart defect, occurring when there is an abnormal opening in the wall separating the two lower chambers of the heart. It allows blood to pass from the left ventricle to the right ventricle. VSDs range from small asymptomatic defects to large defects causing heart failure. They are typically diagnosed via echocardiogram. Small VSDs may require no treatment, while moderate or large defects are often closed surgically or via catheterization.

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708 views

Ventricular Septal Defect

Ventricular septal defect (VSD) is the second most common congenital heart defect, occurring when there is an abnormal opening in the wall separating the two lower chambers of the heart. It allows blood to pass from the left ventricle to the right ventricle. VSDs range from small asymptomatic defects to large defects causing heart failure. They are typically diagnosed via echocardiogram. Small VSDs may require no treatment, while moderate or large defects are often closed surgically or via catheterization.

Uploaded by

pepotch
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Ventricular Septal

Defect
VSD
• Epidemiology
 Second most common cardiac malformation
 Accounts for ~1/5 of all congenital cardiac
anomalies
 Frequency: 1.5-3.5/1000 term infants; 4.5-
7/1000 preterm infants
 No racial predilection exists
 Slightly more common in females than in
males (56% vs. 44%)
 Usually diagnosed in children
VSD
• Disease Definition and Types
 Is a defect in the interventricular septum, which is
composed of muscular and membranous segments
 The hole results in the communication between the
ventricular cavities
 May occur as an isolated anomaly or in association
with a wide variety of cardiac anomalies (TOF,
complete AV canal defects, transposition of great
arteries, and corrected transpositions)
 Several classifications have been proposed
 Most common type is the perimembranous defect, also
referred to by some as conoventricular
 Other 3 are the muscular, subaortic or subarterial and the
inlet type
VSD
Defect allows communication between systemic
and pulmonary circulations
Flow moves from a region of high pressure to a region of
low pressure (LV to RV)
Increased RV flow  Increased PA flow  dilated PA
(increased pulmonary markings)
Increased PA flow  Increased Pulmonary vein flow 
Increased return to LA  Left Atrial Enlargement
Increased LA flow  Increased LV flow  Left
Ventricular Enlargement
Increased RV flow  Right Ventricular Enlargement
VSD
• Clinical Presentation
 Depends on size of defect and magnitude of
L-to-R shunt
 Ranges from asymptomatic patients to those
presenting with exertional dyspnea, cyanosis,
chest pain, syncope, and hemoptysis
 On PE: asymptomatic to patients with poor
growth and CHF
• Differential Diagnosis
 PDA
 Pulmonary Stenosis, Infundibular
VSD
• Laboratory Work-up
CXR
2D-Echo with Doppler – determine size
and location of virtually all VSDs
MRI – adjunct tool; used infrequently
Transesophageal Echocardiography (TEE)
– occasionally used; utilized in pediatric
patients to assess for completeness of
repair
VSD
• Radiographic Findings
Enlarged LV and LA, along with RV
Increased pulmonary vasculature
RV size increases as PA pressure increases
Aorta normal in size
Heart is normal in size but is often enlarged
There may be LA enlargement resulting in
recognizable displacement of esophagus in
lateral projections
VSD
VSD
• Treatment
Surgery is not recommended for patients with
normal PA pressures with small shunts
(pulmonary-to-systemic flow ratios of <1.5 to 2.0:
1.0)
Operative correction or transcathether closure –
indicated when there is moderate L-to-R shunt
(pulmonary-to-systemic flow ratio > 1.5:1.0 or
2.0:1.0), in the absence of prohibitively high levels
of pulmonary vascular resistance

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