Congenital heart defects: VSD

Question 1

VSD is

Answer 1

most common congenital heart defect

-girls and boys equal

Question 2

defect for VSD is in

Answer 2

closure in interventricular septum

Question 3

abnormal cardiac transcription factors

Answer 3

NKx2.5, GATA4, TBX5
22q11 deletion
Holt-oram syndrome

Question 4

most common VSD

Answer 4

membraneous

Question 5

what determines shunt?

Answer 5

left to right shunt determined by size and pulmonary vascular resistance

Question 6

presentation of VSD

Answer 6

• normal at birth

- holosystolic murmur at left sternal border by 2 weeks

Question 7

what can large VSD defects cause?

Answer 7

CHF
holosystolic murmur also has diastolic rumble (apex)
prominent L precordium
palpable sternal lift
systolic thrill
apical thrust

Question 8

CXR shows

Answer 8

cardiomegaly
increased pulmonary vascular markings
prominent RA and pulmonary artery (pleural effusion)

Question 9

ECG shows

Answer 9

biventricular hypertrophy

peaked or notched P waves

Question 10

Echoshows

Answer 10

demonstrates position and size of the VSD, and size of shunt and pulmonary pressures

Question 11

Cardiac cath shows

Answer 11

unnecessary unless size of shunt unclear

clinically confusing presentation

Question 12

prognosis and complications

Answer 12

dependent on size
small usually close
moderate to large can: close, get smaller, or lead to CHF

Question 13

untreated CHF

Answer 13

growth failure

pulmonary infections

Question 14

persistent increased pulmonary flow

Answer 14

eisenmonger’s physiology and cyanosis

-dilated pulmonary artery secondary to pulmonary hypertension

Question 15

longterm risk with VSD

Answer 15

bacterial endocarditis

Question 16

treatment for VSD

Answer 16

small: close up
Large: treat CHF
-if unresponsive: surgically close
exercise to tolerance

Question 17

CHF treatment

Answer 17

diuretics
ACE-I
ARB
nitrates
milrinone (or CCB)
monitor growth

Question 18

precutaneous closure of VSD

Answer 18

-safe, 80%, residual mild to trivial defect 17%, with .7% requiring surgical closure

Question 19

complications of precutaneous closure of VSD

Answer 19

• complete AV block which occurs late (1 week) and requires pacemaker
• hemolysis
• sepsis
• device embolization
• post implantation arrhythmias
• thrombosis and rarely death