Ventricular septal defect

Background

A defect in the septum of the heart which separates the left and right ventricles
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
Clinical presentation will vary depending on comorbid conditions

Small VSDs
- Will generally be asymptomatic
Moderate Size VSDs
- May be asymptomatic
- May develop heart failure symptoms in childhood or early adulthood
- VSD may decrease in size without intervention as patient ages
Large VSDs
- Left-to-right shunts causing heart failure in infancy
- may present with cyanosis, dyspnea, poor feeding, or failure to thrive
VSD murmurs are best heard over the lower left sternal boarder
- Characterized as a holosystolic murmur
- Often, the small the defect, the louder the murmur

Echocardiogram
- This is the 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
Electrocardiogram (EKG)
- most patients with VSDs will have a normal EKG
- conduction delay or RBBB may be seen in large defects
Chest X Ray
- typically normal in patients with VSDs
- may show cardiomegaly with enlarged left ventricle and atrium

40-60% of these defects require no intervention an 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
Patient's with unrepaired VSDs are at increased risk for
- endocarditis
- Arrhythmias
  - Premature Ventricular Beats (PVCs)
  - Ventricular tachyarrhythmias
  - Sudden death
  - Congestive heart failure
  - Aortic regurgitation
  - COPD
  - Pulmonary Hypertension
Treatment is aimed at reducing the complications associated with the VSD, as highlighted above

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.

Authors: