Ventricular septal defect: Difference between revisions
| Line 36: | Line 36: | ||
**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 | ||
**Often used to follow VSDs for spontaneous closure | |||
*[[EKG]] | *[[EKG]] | ||
** | **Most patients with have normal EKGs | ||
**conduction | **Large defects may produce conduction delays or RBBB | ||
*[[CXR]] | *[[CXR]] | ||
** | **Usually normal | ||
** | **May show cardiomegaly with enlarged left ventricle and atrium | ||
**May show signs of CHF | |||
==Management== | ==Management== | ||
Revision as of 16:22, 19 March 2019
Background
- Defect in 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 presentations 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
- Smaller defects produce louder murmurs
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
- Often used to follow VSDs for spontaneous closure
- EKG
- Most patients with have normal EKGs
- Large defects may produce conduction delays or RBBB
- CXR
- Usually normal
- May show cardiomegaly with enlarged left ventricle and atrium
- May show signs of CHF
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.