CVS - Ventricular Septal Defects (VSDs)

Question 1

What is a Ventricular Septal Defect?

Answer 1

Congenital hole in the septum between the two ventricles, which can vary in size from tiny to the entire septum to form one large ventricle.

Question 2

Associated Conditions of VSD (7).

Answer 2

1. Can occur in isolation but often underlying genetic condition.
2. Down’s syndrome.
3. Turner’s Syndrome.
4. Patau Syndrome.
5. Cri-du-Chat Syndrome.
6. Congenital Infections.
7. Post-Myocardial Infections.

Question 3

Epidemiology of VSD.

Answer 3

Commonest cause of CHD.

Question 4

Clinical Features of VSD (8).

Answer 4

1. Often asymptomatic and can present as late as childhood.
2. Poor Feeding.
3. Dyspnoea.
4. Tachypnoea.
5. Failure to Thrive (more energy diverted to breathing instead of growing).
6. Pan-Systolic Murmur (over Tricuspid Area).
7. Systolic thrill on palpation.
8. Heart Failure - Hepatomegaly, Tachycardia, Pallor.

Question 5

Pathophysiology of VSD (4).

Answer 5

1. Increased pressure in LV (than RV) means blood flows from LV to RV.
2. Blood can still flow around lungs before entering rest of the body so acyanotic.
3. Left-to-right shunt leads to right-sided overload, right heart failure and increased blood flow to pulmonary vessels.
4. All is ok until Eisenmenger Syndrome.

Question 6

Diagnosis of VSD (2).

Answer 6

1. Antenatal Scans.

2. Murmur in Newborn Baby Check.

Question 7

Management of VSD (2).

Answer 7

1. Small/Asymptomatic/No Evidence of Pulmonary Hypertension or Heart Failure = Watch-and-Wait (Close spontaneously).
2. Surgical Correction - Transvenous Catheter Closure via Femoral Vein or Open Heart Surgery.

Question 8

Prognosis of VSD (2).

Answer 8

1. Close spontaneously in around 50% of cases.
2. Moderate-to-large VSDs usually result in a degree of HF in the first few months so require nutritional support, medications e.g. Diuretics and surgical closure.

Question 9

Complications of VSD (5).

Answer 9

1. Aortic Regurgitation (poorly supported right coronary cusp = cusp prolapse).
2. Infective Endocarditis.
3. Eisenmenger’s Complex (indication for heart-lung transplant).
4. Right Heart Failure.
5. Pulmonary Hypertension (pregnancy is contraindicated, due to a 30-50% risk of mortality).