VSD Flashcards
What are clinical features of VSD?
- Asymptomatic
- Cardiac failure
- Failure to thrive
- Exercise intolerance
- Recurrent chest infections
- Endocarditis
- Cyanosis (at 10-20 yrs with untreated VSD and pulmon HTN)
Examination findings of VSD?
Depend on size
- Murmur. Loud pansystolic, LLSE, parasternal thrill +/- Mid diastolic
- Loud P2 if pulmonary hypertension or large shunt
ECG findings in VSD?
- Normal if small
- LVH and LAH if moderate
- BVH +/- LAH if large
- RVH if pulmonary vascular disease develops
CXR findings in VSD?
Cardiomegaly (LA, LV and sometimes RV) prop’ on degree of shunt
Pulmonary plethora
What percentage of small to moderate muscular VSDs close spontaneously and when?
60% and not after 8 yrs of age
What percentage of small perimembranous VSDs close spontaneously?
35% and not after 5 yrs
What types of VSDs don’t close spontaneously?
Inlet and outlet (infundibular)
When does CHF usually develop in infants?
6-8 weeks
When does pulmonary vascular disease and eisenmengers develop?
6-12 months and teenage years
What is the medical management of VSD?
- CHF Rx
- Diuretics +/- Digoxn
- (Spirolactone to reduce K+ loss)
- Afterload reducing agents eg Captopril (ACE can increase K+)
- High calorie frequent feeds
- Correct anaemia with oral Fe theray
- No exercise restriction UNLESS pulmonary hypertension
Indications of surgical repair of VSD?
- Severe symptoms of FTT (not responding to medical therapy)
- Pulmonary hypertension
- Aortic regurgitation
- Persistent significant shunting >10yrs of age.
Contraindications to surgery in VSD?
Pulmonary to systemic vascular resistance >0.5 OR
Pulmonary vascular obstructive disease with R–>L shunt
What types of VSD present and their frequency?
- Perimembranous- (Beneath the aortic arch) 70%
- Outlet- (Infundibular/conal/supracristal/subpulmonary) 5-7% Risk of Aortic leaf prolapse and AR
- Inlet- (AV canal, beneath septal leaflet of tricuspid) 5-8%
- Trabecular (Muscular)- frequently multiple. 5-20%
