View source for Ventricular septal defect

==Background==
[[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
*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==
===Non-Congenital Presentations===
*[[Tricuspid regurgitation]]
*[[Mitral regurgitation]]
*[[Hypertrophic cardiomyopathy]]

{{Congenital heart disease DDX}}

==Evaluation==
[[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.]]
*[[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: 
**[[Endocarditis]]
**[[Arrhythmia]]
***[[Premature ventricular contractions]] (PVCs)
***[[Ventricular tachycardia|Ventricular tachyarrhythmias]]
***Sudden death
***[[Congestive heart failure]]
***[[Aortic regurgitation]]
***[[COPD]]
***[[Pulmonary hypertension]]
*Treatment aimed at reducing complications

==Disposition==
*Suspected VSDs require workup by a cardiologist
*Once surgery becomes an option, surgical consultation is recommended

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

==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==
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[[Category:cardiology]]