Ventricular septal defect: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Ventricular Septal Defect.jpg|thumb|[[Echo]] showing a moderate ventricular septal defect in the mid-muscular part of the septum. The trace in the lower left shows the flow during one complete cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colours are used to represent the velocity of the blood. Flow is from the left ventricle (right on image) to the right ventricle (left on image). The size and position is typical for a VSD in the newborn period.]] | |||
*[[Echocardiography]] | *[[Echocardiography]] | ||
**Most important clinical test | **Most important clinical test | ||
Revision as of 18:26, 6 November 2024
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
Echo showing a moderate ventricular septal defect in the mid-muscular part of the septum. The trace in the lower left shows the flow during one complete cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colours are used to represent the velocity of the blood. Flow is from the left ventricle (right on image) to the right ventricle (left on image). The size and position is typical for a VSD in the newborn period.
- 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.