Ventricular septal defect Flashcards
(12 cards)
What is a VSD?
A congenital hole in the ventricular septum. It can vary from tiny to the entire septum, forming one large ventricle.
What can VSDs be associated with?
Can occur in isolation or can be associated with an underlying genetic condition, e.g., Down’s or Turner’s syndrome.
What is the pathophysiology of VSD?
Due to the increased pressure in the LV compared to the right, blood flows from the LV to the RV through the VSD. Blood is still flowing around the lungs before entering the rest of the body, therefore they remain acyanotic as their blood is properly oxygenated.
What are the consequences of a L to R shunt in VSD?
A L to R shunt leads to right-sided overload, right heart failure, and increased flow into the pulmonary vessels. The extra blood flowing through the RV increases pressure in the pulmonary vessels over time, leading to pulmonary hypertension.
What happens if pressure in the right heart exceeds the left side of the heart?
Blood will be shunted from right to left, avoiding the lungs, and the patient will then become cyanotic as blood is bypassing the lungs, resulting in Eisenmenger syndrome.
How can VSDs be picked up?
Antenatal scans and newborn baby checks where a murmur might be heard.
What are typical symptoms of VSD?
Poor feeding, dyspnoea, tachypnoea, and failure to thrive.
What might be heard on examination of a VSD?
A pan systolic murmur, more prominently heard at the left lower sternal border in the 3rd and 4th intercostal spaces. There may be a systolic thrill on palpation.
Is the murmur louder in smaller or bigger defects?
Heard louder in smaller defects.
What is the management for VSD?
Active monitoring as small VSDs with no symptoms or evidence of pulmonary hypertension or heart failure can close spontaneously. Surgical management using a transvenous catheter closure via the femoral vein or open heart surgery.
What is there an increased risk of with VSD?
Infective endocarditis, so antibiotic prophylaxis should be considered during surgical procedures to reduce the risk of developing infective endocarditis.
What are the complications of VSD?
Aortic regurgitation, infective endocarditis, Eisenmenger syndrome, right heart failure, and pulmonary hypertension.
