2 - Paeds - CVS - Ventricular Septal Defect

Question 1

how common?

where is defect? 2 types?

Answer 1

common - 30% of CHD
anywhere in VS
-perimembranous (adj to tricuspid valve)
-muscular (surrounded by muscle)

Question 2

how do we differentiate between small and large VSD?

Answer 2

VSD diameter

small < 3 < medium/mod < 6 < large

Question 3

Small VSD

• Sx?
• Signs?

Answer 3

aSx

loud pansystolic murmur at lower left sternal edge (louder = smaller)
quiet pulmonary HS2

Question 4

Large VSD

-Sx?

Answer 4

Sx - HF with SOB and failure to thrive after 1wk. recurrent chest infections

Question 5

Large VSD

signs?

Answer 5

signs - tachypnoea, tachycardia, hepatomegaly.
active precordium. soft/no pansystolic murmur. apical mid-diastolic murmur (inc flow through mitral valve after lungs). loud pulm HS2 due to raised pulm arterial pressure

Question 6

Ix done for ?VSD

Answer 6

CXR, ECG, Echo

Question 7

Ix findings for small and larger VSD?

Answer 7

small
CXR - normal
ECG - normal
Echo - anatomy of defect

large
CXR - Cardiomegaly, enlarged pulm arteries + vascular markings, pulm. oedema
ECG - Biventricular hypertrophy (by 2m age)
Echo - anatomy of defect

Question 8

MGMT of small VSD

Answer 8

spontaneous closure

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