Ventricular septal defect

Question 1

What is a ventricular septal defect?

Answer 1

Hole in the septum in the heart dividing the right and left ventricles

Question 2

What percentage of children with a congenital heart defect does VSD affect?

Answer 2

50%

Question 3

What are the two types of defects of VSD

Answer 3

Peri membranous

Muscular

Question 4

Describe peri membranous defects

Answer 4

Occur in the upper, membranous portion of the ventricular septum, near the valves
Most common - 70% of VSDs

Question 5

Describe muscular VSD

Answer 5

Where the opening is in the lower, muscular section of the septum - accounts for 20%

Question 6

Describe the pathophysiology of a VSD

Answer 6

Very small/restrictive VSD - asymptomatic as blood flow through VSD is minimal/absent

Moderate VSD - Flow of blood through VSD increases blood in pulmonary circulation. Shunt happens in systole. Left to right shunt

Large VSD - a large volume of blood flowing through VSD, increases pulmonary circulation pressure, patients develop early heart failure and severe pulmonary hypertension

Question 7

What is Eisenmenger’s syndrome

Answer 7

Gradual increase in pulmonary vascular resistance resulting in a reversal of the shunt from left to right to right to left
Deoxygenated blood enters systemic circulation and causes cyanosis

Question 8

List some risk factors for VSD

Answer 8

Maternal DM
Maternal rubella
Alcohol
Uncontrolled maternal phenylketonuria
Congenital conditions - downs, trisomy 13, trisomy 18, holt-oram syndrome

Question 9

List some possible symptoms of VSD

Answer 9

Excessive sweating
Tachypnoea
Fatigue
Developmental issues
Problems feeding

Question 10

Give some examination findings of VSD

Answer 10

Undernourished
Sweating
Increased work of breathing 
Cyanosis
Congenital deformities
Clubbing
Increased HR
Hyperactive precordium on palpation 
Thrill on lower left sternal border 
Systolic murmur lower left sternal border - pan systolic/early systolic
Diastolic murmur apex - apical rumble

Question 11

What investigations can be done for VSD

Answer 11

ECG - left ventricular hypertrophy 
Bloods - septic screen and microarray 
CXR
ECHO
Cardiac CT angiography 
MRI
Cardiac catheterisation

Question 12

Describe the management of VSD

Answer 12

Increase calories
Diuretics - furosemide
ACEi
Digoxin
Surgical repair by open or catheter procedure or hybrid procedure
Pulmonary artery banding for palliation until surgery can be done
Maintain good oral hygiene and avoid tattoos and piercings - risk of infective endocarditis
Regular cardiac follow up

Question 13

List some complications of untreated VSD

Answer 13

Congestive heart failure
Growth failure
Aortic valve regurgitation 
Pulmonary vascular disease
Frequent chest infections
Infective endocarditis
Arrhythmias 
Sudden death