VSD

Question 1

Aetiology

Answer 1

• commonest congenital heart defect (25-40% of CHD)
• mostly congenital
• acquired (eg 24-72h post-MI, sudden haemodynamic compromise, new loud systolic murmur, very poor prognosis without early surgery)

Question 2

Symptoms

Answer 2

• often asymptomatic
• in infancy, large lesions will present with heart failure
• in adulthood most likely to be incidental finding but may also present with high-output heart failure

Question 3

Signs

Answer 3

• pansystolic with with ejection character. Loudest LSE (classically 4th ICS). If muscular defect then will not span whole of systole
• associated thrill
• RV heave if shunt is severe enough to cause TV overload
• right heart failure (universally the case in Gerbode defect with marked and relatively fixed JVP)
• in rare uncorrected cases secondary pulmonary HTN develops ultimately reversing the shunt giving rise to signs of eisenmengers syndrome
• the classic maladie de Rogers is isolated loud ejection pap-systolic murmur with no other signs (suggests small VSD)

Question 4

Investigations

Answer 4

Echo to determine size and severity but also looking for other defects

Question 5

Complications

Answer 5

Unlikely in small VSD. In large VSD complications are namely heart failure and endocarditis

Question 6

Management

Answer 6

• reassurance in small VSD
• large defects, or those presenting with complications need surgical repair. Percutaneous catheter based repair is an option