Acyanotic: VSD Flashcards
MC cardiac malformation
VSD
MC type of VSD
Membranous
VSD in the midportion or apical region of the ventricular septum are what type
Muscular
Swiss cheese septum
Muscular VSD
Small VSD is defined as
<5mm
A small VSD is pressure restrictive, meaning
RV pressure is normal
Large VSD is defined as
> 10mm
T/F RV and LV pressures are equalized in large nonrestrictive VSDs
T
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
1:1
Small shunt is defined by a Qp:Qs of
<1.5:1
T/F When the shunt is small, cardiac chambers are not appreciably enlarged and pulmonary vascular bed is likely normal
T
Large shunt is defined by a Qp:Qs pf
> 2:1
CHD: Loud harsh or blowing HSM best heard over the left lower sternal border, frequently accompanied by a thrill
VSD
CHD: Short, harsh systolic murmur localized to the apex of a neonate
Tiny VSD in the apical muscular septum
T/F HSM of a large VSD is generally less harsh than that of a small VSD
T
T/F HSM of a large VSD is more blowing than that of a small VSD
T, due to the absence of a significant pressure gradient across the defect
T/F In patients with hyperdynamic pulmonary htn, pulmonary vascular resistance is only minimally elevated
T, because resistance = pressure/flow
Definition of hyperdynamic pulmonary htn
Pulmonary blood flow 2-4x systemic blood flow
30-50% of small VSDs close spontaneously, most frequently during
1st 2 years of life
Muscular vs membranous VSDs, more likely to close
Muscular (up to 80%; membranous up to 35% only)
Vast majority of VSDs that close do so before ___ yrs old
4
T/F An isolated, small, hemodynamically insignificant VSD is not an indication for surgery
T
Patients with VSD are at risk for developing aortic valve regurgitation; greatest risk occurs with what type of VSD
Supracristal
T/F Antibiotic prophylaxis is recommended for dental visits and surgical procedures of patients with VSD
F
T/F In infants with large VSD, even with well-controlled heart failure, surgery should not be delayed
T, UNLESS there is evidence that the defect is becoming pressure restrictive
Indications for surgical closure of VSD
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
