Acyanotic: VSD

Question 1

MC cardiac malformation

Answer 1

VSD

Question 2

MC type of VSD

Answer 2

Membranous

Question 3

VSD in the midportion or apical region of the ventricular septum are what type

Answer 3

Muscular

Question 4

Swiss cheese septum

Answer 4

Muscular VSD

Question 5

Small VSD is defined as

Answer 5

<5mm

Question 6

A small VSD is pressure restrictive, meaning

Answer 6

RV pressure is normal

Question 7

Large VSD is defined as

Answer 7

> 10mm

Question 8

T/F RV and LV pressures are equalized in large nonrestrictive VSDs

Answer 8

T

Question 9

When the ratio of pulmonary to systemic resistance approaches ___, shunt in VSD becomes bidirectional, signs of heart failure abate, and patient begins to show signs of cyanosis

Answer 9

1:1

Question 10

Small shunt is defined by a Qp:Qs of

Answer 10

<1.5:1

Question 11

T/F When the shunt is small, cardiac chambers are not appreciably enlarged and pulmonary vascular bed is likely normal

Answer 11

T

Question 12

Large shunt is defined by a Qp:Qs pf

Answer 12

> 2:1

Question 13

CHD: Loud harsh or blowing HSM best heard over the left lower sternal border, frequently accompanied by a thrill

Answer 13

VSD

Question 14

CHD: Short, harsh systolic murmur localized to the apex of a neonate

Answer 14

Tiny VSD in the apical muscular septum

Question 15

T/F HSM of a large VSD is generally less harsh than that of a small VSD

Answer 15

T

Question 16

T/F HSM of a large VSD is more blowing than that of a small VSD

Answer 16

T, due to the absence of a significant pressure gradient across the defect

Question 17

T/F In patients with hyperdynamic pulmonary htn, pulmonary vascular resistance is only minimally elevated

Answer 17

T, because resistance = pressure/flow

Question 18

Definition of hyperdynamic pulmonary htn

Answer 18

Pulmonary blood flow 2-4x systemic blood flow

Question 19

30-50% of small VSDs close spontaneously, most frequently during

Answer 19

1st 2 years of life

Question 20

Muscular vs membranous VSDs, more likely to close

Answer 20

Muscular (up to 80%; membranous up to 35% only)

Question 21

Vast majority of VSDs that close do so before ___ yrs old

Answer 21

4

Question 22

T/F An isolated, small, hemodynamically insignificant VSD is not an indication for surgery

Answer 22

T

Question 23

Patients with VSD are at risk for developing aortic valve regurgitation; greatest risk occurs with what type of VSD

Answer 23

Supracristal

Question 24

T/F Antibiotic prophylaxis is recommended for dental visits and surgical procedures of patients with VSD

Answer 24

F

Question 25

T/F In infants with large VSD, even with well-controlled heart failure, surgery should not be delayed

Answer 25

T, UNLESS there is evidence that the defect is becoming pressure restrictive

Question 26

Indications for surgical closure of VSD

Answer 26

1) Any age with large defects in whom clinical symptoms and failure to thrive cannot be controlled immediately 2) Between 6-12 mos infants with large defects associated with pulmonary htn, EVEN IF SYMPTOMS ARE CONTROLLED BY MEDICATION 3) >24 months with Qp:Qs ratio >2:1