Ventricular septal defect: Difference between revisions
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==Background== | ==Background== | ||
* | [[File:VSD.jpg|thumb|]] | ||
*Defect in the septum separating left and right ventricles | |||
*Second most common congenital heart defect | *Second most common congenital heart defect | ||
* | *Can be isolated, due to chromosomal abnormalities (5%), or coexist with other heart defects such as [[Tetralogy of Fallot]] | ||
*Clinical presentation | *Clinical presentation vary depending on comorbid conditions | ||
==Clinical Presentation== | ==Clinical Presentation== | ||
*Small VSDs | *Small VSDs | ||
** | **Generally asymptomatic | ||
*Moderate Size VSDs | *Moderate Size VSDs | ||
**May be asymptomatic | **May be asymptomatic | ||
** | **+/- [[heart failure]] symptoms in childhood or early adulthood | ||
** | **May decrease in size without intervention as patient ages | ||
*Large VSDs | *Large VSDs | ||
**Left-to-right shunts causing heart failure in infancy | **Left-to-right shunts causing [[heart failure]] in infancy | ||
** | **Cyanosis, [[dyspnea]], poor feeding, or [[failure to thrive]] | ||
*VSD | *VSD [[murmur]] | ||
**Best heard over the lower left sternal boarder | |||
**Characterized as a holosystolic murmur | **Characterized as a holosystolic murmur | ||
**Often, the | **Often, the smaller the defect, the louder the murmur | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Pulmonary stenosis | *Pulmonary stenosis | ||
*Patent ductus | *[[Patent ductus arteriosus]] | ||
* | *[[Tetralogy of Fallot]] | ||
*Aortic stenosis | *Aortic stenosis | ||
*Tricuspid regurgitation | *Tricuspid regurgitation | ||
*Mitral | *[[Mitral regurgitation]] | ||
*Hypertrophic | *[[Hypertrophic cardiomyopathy]] | ||
==Evaluation== | ==Evaluation== | ||
* | *[[Echocardiography]] | ||
** | **Most important clinical test | ||
**High detection rate for VSD | **High detection rate for VSD | ||
**Allows operator to visualize the defect and assess how much bloodflow is crossing the defect by using color flow Doppler | **Allows operator to visualize the defect and assess how much bloodflow is crossing the defect by using color flow Doppler | ||
**Allows for detection of other possible structural defects | **Allows for detection of other possible structural defects | ||
* | *[[EKG]] | ||
**most patients with VSDs will have a normal EKG | **most patients with VSDs will have a normal EKG | ||
**conduction delay or RBBB may be seen in large defects | **conduction delay or RBBB may be seen in large defects | ||
* | *[[CXR]] | ||
**typically normal in patients with VSDs | **typically normal in patients with VSDs | ||
**may show cardiomegaly with enlarged left ventricle and atrium | **may show cardiomegaly with enlarged left ventricle and atrium | ||
==Management== | ==Management== | ||
*40-60% | *40-60% require no intervention, will spontaneously close in early childhood | ||
*Surgical closure (often done percutaneously) | *Surgical closure (often done percutaneously) | ||
* | **definitive treatment for defects that do not close on their own and cause significant disability | ||
** | *Patients with unrepaired VSDs are at increased risk for: | ||
** | **[[Endocarditis]] | ||
***Premature | **[[Arrhythmia]] | ||
***Ventricular tachyarrhythmias | ***[[Premature ventricular contractions]] (PVCs) | ||
***[[ventricular tachycardia|Ventricular tachyarrhythmias]] | |||
***Sudden death | ***Sudden death | ||
***Congestive heart failure | ***[[Congestive heart failure]] | ||
***Aortic regurgitation | ***[[Aortic regurgitation]] | ||
***COPD | ***[[COPD]] | ||
***Pulmonary | ***[[Pulmonary hypertension]] | ||
*Treatment is aimed at reducing | *Treatment is aimed at reducing complications associated with the VSD | ||
==Disposition== | ==Disposition== | ||
*Suspected VSDs require workup by a cardiologist | *Suspected VSDs require workup by a cardiologist | ||
*Once surgery becomes an option, surgical consultation is recommended | *Once surgery becomes an option, surgical consultation is recommended | ||
==See Also== | ==See Also== | ||
*[[Congenital heart disease]] | |||
==External Links== | ==External Links== | ||
Revision as of 21:30, 31 August 2017
Background
- Defect in the septum separating left and right ventricles
- Second most common congenital heart defect
- Can be isolated, due to chromosomal abnormalities (5%), or coexist with other heart defects such as Tetralogy of Fallot
- Clinical presentation vary depending on comorbid conditions
Clinical Presentation
- Small VSDs
- Generally asymptomatic
- Moderate Size VSDs
- May be asymptomatic
- +/- heart failure symptoms in childhood or early adulthood
- May decrease in size without intervention as patient ages
- Large VSDs
- Left-to-right shunts causing heart failure in infancy
- Cyanosis, dyspnea, poor feeding, or failure to thrive
- VSD murmur
- Best heard over the lower left sternal boarder
- Characterized as a holosystolic murmur
- Often, the smaller the defect, the louder the murmur
Differential Diagnosis
- Pulmonary stenosis
- Patent ductus arteriosus
- Tetralogy of Fallot
- Aortic stenosis
- Tricuspid regurgitation
- Mitral regurgitation
- Hypertrophic cardiomyopathy
Evaluation
- Echocardiography
- Most important clinical test
- High detection rate for VSD
- Allows operator to visualize the defect and assess how much bloodflow is crossing the defect by using color flow Doppler
- Allows for detection of other possible structural defects
- EKG
- most patients with VSDs will have a normal EKG
- conduction delay or RBBB may be seen in large defects
- CXR
- typically normal in patients with VSDs
- may show cardiomegaly with enlarged left ventricle and atrium
Management
- 40-60% require no intervention, will spontaneously close in early childhood
- Surgical closure (often done percutaneously)
- definitive treatment for defects that do not close on their own and cause significant disability
- Patients with unrepaired VSDs are at increased risk for:
- Treatment is aimed at reducing complications associated with the VSD
Disposition
- Suspected VSDs require workup by a cardiologist
- Once surgery becomes an option, surgical consultation is recommended
See Also
External Links
- Ventricular septal defects | circulation Retrieved 8/18/2017, 2017, from http://circ.ahajournals.org/content/114/20/2190
- Du ZD, Roguin N, Wu XJ. Spontaneous closure of muscular ventricular septal defect identified by echocardiography in neonates. Cardiol Young 1998; 8:500.