Ventricular septal defect: Difference between revisions
| Line 48: | Line 48: | ||
*40-60% require no intervention, will spontaneously close in early childhood | *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 spontaneously close and cause disability | ||
*Patients with unrepaired VSDs | *Patients with unrepaired VSDs at increased risk for: | ||
**[[Endocarditis]] | **[[Endocarditis]] | ||
**[[Arrhythmia]] | **[[Arrhythmia]] | ||
***[[Premature ventricular contractions]] (PVCs) | ***[[Premature ventricular contractions]] (PVCs) | ||
***[[ | ***[[Ventricular tachycardia|Ventricular tachyarrhythmias]] | ||
***Sudden death | ***Sudden death | ||
***[[Congestive heart failure]] | ***[[Congestive heart failure]] | ||
| Line 59: | Line 59: | ||
***[[COPD]] | ***[[COPD]] | ||
***[[Pulmonary hypertension]] | ***[[Pulmonary hypertension]] | ||
*Treatment | *Treatment aimed at reducing complications | ||
==Disposition== | ==Disposition== | ||
Revision as of 16:23, 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 spontaneously close and cause disability
- Patients with unrepaired VSDs at increased risk for:
- Treatment aimed at reducing complications
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.