VENTRICULAR SEPTAL DEFECT (VSD)

VENTRICULAR SEPTAL DEFECT (VSD)

       DEFINITION

• Abnormal communication between ventricles
• Left to right shunt
• The defect can occur anywhere in the ventricular septum and are classified into four types:
•   Supracrystal: below valve,associated with aortic valve insufficiency
•  Perimembranous
•  AV (atrioventricular) canal type
•  Muscular

      

 EPIDEMIOLOGY

• Most common form of congenital heart disease, 20 – 25%
• Spontaneous closure occur in 30% to 40% of all cases (usually in 1^st year of life)
• Males > females
• Associated with tetralogy of fallot, transposition of the great arteries, truncus arteriosus and coarctation of the aorta

  PATHOPHYSIOLOGY

• Left to right shunt
• Overcirulation of the pulmonary bed
• Right ventricular overload resulting in right ventricular hypertrophy

  CLINICAL SIGNS AND SYMPTOMS

• Congestive heart failure (CHF) in infants with large defects
• Grade 2 – 5/6 regurgitate systolic murmur at the left lower sternal border
• EKG: small VSD: normal; mod VSD: left ventricular hypertrophy, left atrial hypertrophy (LAH) . Large VSD: CHF, LAF (left atrial hypertrophy), biventricular hypertrophy
• Chest x-ray normal to cardiomegaly
• ECHO (echocardiogram) – determine size of defect, location, shunting, associated defects

  MEDICAL MANAGEMENT

• Digoxin
• Diuretics
• Nutritional support 

  SURGICAL MANAGEMENT

• Closure
•   Primary closure involves closure with sutures
•   Patch closure involves using a piece of the patient’s native pericardium or gortex patch
• Pulmonary artery banding
•   A band is placed around the pulmonary artery and limits the amount of blood flow to the lungs. This is a procedure that does not require cardiopulmonary bypass and May opted for when the patient is small for gestational age, or < 3kg 

          Surgical closure of VSD

Pulmonary artery banding