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B - Paediatrics MANAGEMENT > Ventricular Septal Defects > Flashcards

Ventricular Septal Defects Flashcards

1
Q

What are Ventricular Septal Defects (VSD)?

A

Defects in the inter-ventricular septum that allow shunting of blood between the left and right ventricles

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2
Q

Where can VSDs occur?

A

Anywhere in the ventricular septum - they can perimembranous or muscular

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3
Q

What is a perimembranous VSD?

A

Adjacent to the tricuspid valve

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4
Q

What is a muscular VSD?

A

When the VSD is completely surrounded by muscle

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5
Q

How else can VSDs be classified?

A

By size

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6
Q

What is considered a small VSD?

A

Smaller than the aortic valve in diameter up to 3mm

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7
Q

What is considered a large VSD?

A

Same size or bigger than the aortic valve in diameter

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8
Q

What is the aetiology of most VSDs?

A

Congenital

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9
Q

How may an acquire VSD occur?

A

Post-MI or trauma

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10
Q

What percentage of congenital heart disease do VSDs account for?

A

30%

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11
Q

What happens during systole in a heart with VSD?

A

Some blood leaks from the left ventricle into the right ventricle

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12
Q

Where does blood that shunts from the LV to the RV then travel?

A

Through the lungs and back to the left ventricle

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13
Q

What does re-circulation of blood to the left ventricle lead to?

A

Volume overload of the left ventricle, rise in right ventricle pressure and volume leading to pulmonary hypertension and associated symptoms

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14
Q

What may occur in serious cases of VSD?

A

The pulmonary artery pressure can reach levels equal to the systemic circulation reversing the left to right shunt

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15
Q

What will reversal of the left to right shunt cause?

A

Cyanosis

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16
Q

What are the risk factors for VSD?

A
  • Family history of congenital heart disease
  • Down’s syndrome
  • Maternal alcohol consumption during pregnancy
17
Q

What is the typical presentation of a small VSD?

A

Asymptomatic with a loud pansystolic murmur at the lower left sternal edge, and a quiet pulmonary second sound

18
Q

What symptoms may large VSDs present with?

A
  • Heart failure
  • Recurrent chest infections
  • Tachypnoea and tachycardia
  • Hepatomegaly
  • Active precordium
19
Q

What may be heard on auscultation in a large VSD?

A
  • Soft pansystolic murmur
  • Apical mid-diastolic murmur
  • Loud pulmonary second sound
20
Q

What investigations can be considered in VSD?

A
  • CXR
  • ECG
  • Echo
21
Q

What will a CXR and ECG show in a small VSD?

A

Normal

22
Q

What can an echo be used for in a small VSD?

A

Demonstrating precise anatomy and confirming diagnosis

23
Q

What will a CXR show in a large VSD?

A
  • Cardiomegaly
  • Enlarged pulmonary arteries
  • Increased pulmonary vascular markings
  • Pulmonary oedema
24
Q

What will an ECG show in a large VSD?

A

Biventricular hypertrophy from 2 months

25
Q

What can an echo be used to show in a large VSD?

A
  • Anatomy of defect
  • Haemodynamic effects
  • Pulmonary hypertension
26
Q

What are some differentials for VSD?

A
  • ASD
  • PDA
  • Mitral regurgitation
27
Q

What is the management for a small VSD?

A

Observation and follow-up

28
Q

Why is observation and follow-up used in most small VSDs?

A

Asymtpomatic VSDs often close spontaneously and prognosis of those that fail to close is excellent

29
Q

What may be considered in some patients with small VSDs?

A

Prophylactic antibiotics

30
Q

What prophylactic antibiotics may be used in small VSDs?

A

Amoxicillin or clindamycin

31
Q

What is first line in medium and large VSDs?

A

Corrective closure

32
Q

What does corrective closure of larger VSDs help to prevent?

A
  • Severe pulmonary hypertension
  • Heart failure
  • Eisenmenger’s syndrome
33
Q

How is corrective closure performed in VSD?

A

Patch used to close the VSD

34
Q

What will symptomatic patients need prior to surgery?

A

Medical therapy with furosemide and sometimes with captopril

35
Q

What are some potential complications of VSD?

A
  • Endocarditis
  • Heart failure
  • Pulmonary hypertension
  • Arrhythmias
  • Valve problems

B - Paediatrics MANAGEMENT (106 decks)

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