VSD Flashcards
What is the incidence of VSD?
3-3.5 infants per 1000 live births have a VSD
VSD is the MOST COMMON congenital heart defect at birth
How many VSD types are there? (per STS’s CHD Database Committee)
Which type is most common?
- 4 types
- Type 2 (or perimembranous) VSDs are most common (almost 80%)
Where is a Type 1 VSD? What are synonym names? Which ethnic group is it most common?
Type 1 VSDs lie in the outflow portion of the RV and
account for approximately 6% of defects in non-Asian populations but up to 33% in Asian patients.
-Spontaneous closure is uncommon
-Synonyms: Conal, Subpulmonary, Infundibular, Supracristal
Where is a Type 2 VSD?
-Most common type
-Located in the membranous septum and is adjacent to the septal leaflet of the tricuspid valve, which can become adherent to the defect, thus forming a pouch or “aneurysm” of the ventricular septum. This pouch will limit left-to-right
shunting and can result in partial or complete closure of the
defect. On the LV side of the septum, the defect is adjacent to the aortic valve.
Where is a Type 3 VSD? What are the synonyms? Which group of people is it seen in?
Inlet or AV canal type VSD. Occur in the lower part of the RV and adjacent to the TV. Involves the inlet of the ventricular septum immediately inferior to the AV valve apparatus. Typically occurs in Down Syndrome patients.
Where is a Type 4 VSD?
Type 4 is the “muscular VSD” type and can be located centrally (mid-muscular), apically or at the margin of the septum and RV free wall. They can be multiple in number. Spontaneous Closure is common. These defects account for 20% of VSDs in infants.
Although VSD is most often an isolated lesion, it is a
common component of complex abnormalities such as
conotruncal defects (eg, tetralogy of Fallot, TGA). VSD can
also be associated with left-sided obstructive lesions such as _______ and ________.
Subaortic stenosis and Coarctation of the aorta.
What is a sub pulmonary (supracristal) VSD often associated with?
Progressive aortic valve regurgitation caused by prolapse of the aortic cusp (usually right) through the defect.
How are VSDs sized (small, moderate, large)?
VSDs are sized based on comparison to the aortic annulus.
-Small defects are 74% “”
What will you typically find on exam in a VSD?
Systolic murmur that is usually maximal at the LEFT LOWER STERNAL BORDER.
Small, muscular VSDs are usually very high-pitched and occupy early systole only because muscular contraction closes the defect.
What happens to the VSD murmur in relation to RV pressure?
When RV pressure is low, the VSD murmur is blowing and pan systolic. With incremental increases in RV pressure, the murmur is shorter, softer, and lower pitched.
What is typical to find on ECG with a large VSD and significant PAH?
Biventricular hypertrophy or isolated RVH
What is typical on CXR with a significant left to right shunt?
Left atrial and LV enlargement with increased pulmonary vascular markings
Class IIa
Cardiac catheterization can be useful for adults with VSD in
whom noninvasive data are inconclusive and further information is needed for management. Data to be obtained include the following:
a. Quantification of shunting. (Level of Evidence: B)
b. Assessment of pulmonary pressure and resistance in
with suspected PAH. Reversibility of PAH should be
tested with various vasodilators. (Level of Evidence: B)
c. Evaluation of other lesions such as AR and
right ventricle. (Level of Evidence: C)
d. Determination of whether multiple VSDs are present
surgery. (Level of Evidence: C)
e. Performance of coronary arteriography is indicated in
at risk for coronary artery disease. (Level of Evidence:
C)
f. VSD anatomy, especially if device closure is contemplated
Class IIa
Closure of a VSD is reasonable when net left-to-right
is present at a Qp/Qs greater than ___ with pulmonary
pressure less than___ of systemic pressure and PVR
less than ___ of systemic vascular resistance.
- 1.5
- two thirds
- two thirds
