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 1st 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
