Ventricular Septal Defects

Question 1

Aetiology of VSD

Answer 1

Congenital heart disease:
Downs syndrome
Edwards syndrome
Digeorge syndrome
Turners syndrome
Holt Oram Syndrome
Foetal ETOH syndrome

Secondary;
Septal MI and rupture

Question 2

Types of VSD

Answer 2

Membranous (80%)
Muscular (20%)

Question 3

Clinical signs of VSD (non auscultation)

Answer 3

Signs of RVF:
- Raised JVP
- Pitting oedema
- RV heaves
- Functional TR
- Hepatomegaly

Question 4

Auscultation of VSD

Answer 4

ESM/ PSM which may not include all of systole due to muscular contraction and closure of VSD

Question 5

What is a maladie de roger murmur

Answer 5

Isolated finding of very loud ejections systolic murmur through small VSD (no other signs)

Question 6

What happens to a VSD murmur if Eisenmenger’s occurs

Answer 6

murmur is lost due to reduced gradient of pressures across the defect

Question 7

Differentials to VSD

Answer 7

ASD
Pulmonary stenosis
MR

Question 8

Complications of VSD

Answer 8

Endocarditis
Eisenmenger’s
Pulmonary HTB
RVF
Aortic regurg

Question 9

Investigations of VSD

Answer 9

ECG
XR Chest
TTE/TOE

Question 10

Signs on XR chest

Answer 10

Pulmonary plethora:
Increased pulmonary vasculature
Widening of vessels
increase no. of hilar arteries
cardiomegaly

Question 11

Management of VSD

Answer 11

Small defects do not require managment

non-pharma: High calorie diet
medical: Heart failure meds
Surgical: Pericardial patch, percutaneous closure with fluoroscopic guidance

Question 12

Who is a candidate for closure of VSD?

Answer 12

IE
Significant L -> R shunt
Pulmonary HTN
If requiring cardiac surgery for other conditions

should be done early to avoid Eisenmenger’s