Ventricular septal defect: Difference between revisions
 
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==Background==
==Background==
*A defect in the septum of the heart which separates the left and right ventricles
[[File:VSD.jpg|thumb|Ventricular septal defect]]
[[File:Vsd simple-lg.jpg|thumb|Illustration showing various forms of ventricular septal defects. 1. Conoventricular, malaligned; 2. Perimembranous; 3. Inlet; and 4. Muscular.]]
*Defect in septum separating left and right ventricles
*Second most common congenital heart defect
*Second most common congenital heart defect
*These defects can be isolated, due to chromosomal abnormalities (5%), or coexist with other heart defects such as Tetrology of Fallot
*Can be isolated, due to chromosomal abnormalities (5%), or coexist with other heart defects such as [[Tetralogy of Fallot]]
*Clinical presentation will vary depending on comorbid conditions
*Clinical presentations vary depending on comorbid conditions


==Clinical Presentation==
==Clinical Presentation==
*Small VSDs
*Small VSDs
**Will generally be asymptomatic
**Generally asymptomatic
*Moderate Size VSDs
*Moderate Size VSDs
**May be asymptomatic
**May be asymptomatic
**May develop heart failure symptoms in childhood or early adulthood
**+/- [[heart failure]] symptoms in childhood or early adulthood
**VSD may decrease in size without intervention as patient ages
**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
**may present with cyanosis, dyspnea, poor feeding, or failure to thrive
**Cyanosis, [[dyspnea]], poor feeding, or [[failure to thrive]]
*VSD murmurs are best heard over the lower left sternal boarder
*VSD [[murmur]]
**Best heard over the lower left sternal boarder
**Characterized as a holosystolic murmur
**Characterized as a holosystolic murmur
**Often, the small the defect, the louder the murmur
**Smaller defects produce louder murmurs


==Differential Diagnosis==
==Differential Diagnosis==
*Pulmonary stenosis
===Non-Congenital Presentations===
*Patent ductus arteriosis
*[[Tricuspid regurgitation]]
*Tetrology of Fallot
*[[Mitral regurgitation]]
*Aortic stenosis
*[[Hypertrophic cardiomyopathy]]
*Tricuspid regurgitation
 
*Mitral Regurgitation
{{Congenital heart disease DDX}}
*Hypertrophic Cardiomyopathy


==Evaluation==
==Evaluation==
*Echocardiogram
[[File:Ventricular Septal Defect.jpg|thumb|[[Echo]] showing a moderate ventricular septal defect in the mid-muscular part of the septum. 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.]]
**This is the most important clinical test
*[[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
*Electrocardiogram (EKG)
**Often used to follow VSDs for spontaneous closure
**most patients with VSDs will have a normal EKG
*[[EKG]]
**conduction delay or RBBB may be seen in large defects
**Most patients with have normal EKGs
*Chest X Ray
**Large defects may produce conduction delays or RBBB
**typically normal in patients with VSDs
*[[CXR]]
**may show cardiomegaly with enlarged left ventricle and atrium
**Usually normal
**May show cardiomegaly with enlarged left ventricle and atrium
**May show signs of CHF


==Management==
==Management==
*40-60% of these defects require no intervention an will spontaneously close in early childhood
*40-60% require no intervention, will spontaneously close in early childhood
*Surgical closure (often done percutaneously) is the definitive treatment for defects that do not close on their own and cause significant disability
*Surgical closure (often done percutaneously)  
*Patient's with unrepaired VSDs are at increased risk for  
**Definitive treatment for defects that do not spontaneously close and cause disability
**endocarditis
*Patients with unrepaired VSDs at increased risk for:
**Arrhythmias
**[[Endocarditis]]
***Premature Ventricular Beats (PVCs)
**[[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 Hypertension
***[[Pulmonary hypertension]]
*Treatment is aimed at reducing the complications associated with the VSD, as highlighted above
*Treatment aimed at reducing complications


==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
==Disposition==


==See Also==
==See Also==
 
*[[Congenital heart disease]]


==External Links==
==External Links==

Latest revision as of 18:53, 6 November 2024

Background

Ventricular septal defect
Illustration showing various forms of ventricular septal defects. 1. Conoventricular, malaligned; 2. Perimembranous; 3. Inlet; and 4. Muscular.
  • 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
  • VSD murmur
    • Best heard over the lower left sternal boarder
    • Characterized as a holosystolic murmur
    • Smaller defects produce louder murmurs

Differential Diagnosis

Non-Congenital Presentations

Congenital Heart Disease Types

Evaluation

Echo showing a moderate ventricular septal defect in the mid-muscular part of the septum. 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

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.

References

  1. ↑ Knipe K et al. Cyanotic congenital heart diseases. Radiopaedia. http://radiopaedia.org/articles/cyanotic-congenital-heart-disease
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