Ventricular Septum Defects

Question 1

True or False: VSDs can be very small and go undetected?

Answer 1

True. Pts with small VSDs can be asymptomatic and their condition can go unnoticed. Only hemodynamically significant VSDs will be caught early in life.

Question 2

Which way do VSDs shunt blood?

Answer 2

From left to right. This causes a volume overload to the right heart.

Question 3

What is the most common type of VSD?

Answer 3

A membranous VSD, those located beneath the aortic valve. It is only surgically corrected if it is causing issues.

Question 4

What is Eisenmenger’s complex?

Answer 4

A congenital cyanotic heart defect consisting of a VSD, dextroposition of the AO, pulmonary hypertension with PA enlargement and a hypertrophic RV. It causes systemic pressures on the right side and shunt reversal.

Question 5

If the tissue in a membranous VSD is abnormal what might happen?

Answer 5

The tissue could become a site for infection.

Question 6

What is the second most common type of VSD, and what are its characteristics?

Answer 6

Muscular VSD; it is an abnormal opening in the mid-ventricular septum down to the apex. It can be one small opening or many fenestrations.

Question 7

Which murmur does Muscular VSD mimic?

Answer 7

AS- because it deals with high pressures during systole.

Question 8

What happens if the pressure becomes too intense?

Answer 8

It can rupture a wall; an acute event leading to pulmonary edema. Pt will code.

Question 9

What other event may lead to septal rupture?

Answer 9

Post infarct VSDs. It can be any wall that is necrotic or dead tissue.

Question 10

What happens in fetal development to cause a Muscular VSD?

Answer 10

Malalignment of the truncus and conus septa which do not meet each other, and therefore do not fuse.

Question 11

What VSD consists of no IVS and is very rare?

Answer 11

Common Ventricle VSD.

Question 12

In a Common Ventricle VSD the entire septum is absent except for what?

Answer 12

A low ridge usually present along the posteroinferior ventricular wall.

Question 13

What happens to flow in a Common Ventricle VSD?

Answer 13

Everything empties into a single ventricle, flow still goes out the AO & PA but sats go down due to venous and arterial mixing.

Question 14

True or False: in Common Ventricle VSD the ventricles can become hypertrophic?

Answer 14

True.

Question 15

Define Cyanotic.

Answer 15

Low tissue perfusion, low oxygen causes Pt to have bluish tinge.

Question 16

What is a Supracristal?

Answer 16

An abnormal shunt from the LVOT to the RVOT. It involves the IVS below the pulmonic valve.

Question 17

What is Supracristal associated with?

Answer 17

It is associated with AO valve prolapse and can lead to AI.

Question 18

What is Gerbode?

Answer 18

An abnormal shunt from LV to RA high in the IVS.

Question 19

What does Gerbode put the Pt as risk for?

Answer 19

PE and Stroke.

Question 20

What murmurs are associated with VSDs?

Answer 20

Murmurs of MR, TR, and PS. Harsh systolic murmur is heard over the left sternal border. The murmur is relative to the size of the VSD.

Question 21

Do large VSDs cause more problems than smaller ones?

Answer 21

Yes. Large VSDs cause more complications and Sx. The right heart enlarges and Pt may show signs of CHF.

Question 22

What arrhythmias are associated with VSDs?

Answer 22

PVCs
PACs
RVH on EKG
Increased HR

Question 23

What does a chest xray of a Pt with VSD look like?

Answer 23

May be normal if there is no evidence of CHF. If VSD is significant there will be an increased cardiac silhouette and pulmonary congestion.