Peds
Ventricular Septal Defect
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Ventricular Septal Defect
, VSD
See also
Congenital Heart Disease
Congenital Heart Disease Causes
Epidemiology
Incidence
: 15-25% of
Congenital Heart Disease
Most common
Congenital Heart Disease
cause
Most common CHD found in chromosomal abnormalities
More common in males
Pathophysiology
Defect in interventricular septal wall
Most often located in membranous ventricular septum
Signs and symptoms
Severity of symptoms related to:
Defect size
Pulmonary vascular resistance
Associated cardiac lesions
Small to moderate VSD
Normal P2 component of the
Second Heart Sound
Pansystolic harsh murmur
Grade II-VI of VI
Located at lower left sternal border
Large VSD with significant shunt
Includes moderate VSD findings
Mid-diastolic flow rumble at apex
Congestive Heart Failure
signs and symptoms
Marked
Pulmonary Hypertension
Right Ventricular lift
Loud P2 component of the
Second Heart Sound
Short systolic ejection murmur at left sternal border
Radiology (large defect findings)
Chest XRay
Cardiomegaly
Increased pulmonary vasculature
Echocardiogram
Defines position and size of defect
Management
Medical
Small Ventricular Septal Defect
No surgical repair indicated
SBE Prophylaxis
Congestive Heart Failure
Diuretic
s
Digoxin
Management
Surgical repair indications
Growth failure refractory to medical therapy
Pulmonary Hypertension
Pulmonary to systemic flow ratio > 2:1
Course
Spontaneous closure age <6 months: 30-40% related to:
Membranous and muscular defects
Smaller defects
Complications
Without repair
Congestive Heart Failure
Eisenmenger's Complex
Complications
With repair
Conduction defect: transient
Right Bundle Branch Block
References
Saenz (1999) Am Fam Physician 59(7):1857-66 [PubMed]
Cyran (1998) PREP review lecture, October, Phoenix
Merenstein (1994) Pediatrics, Lange
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