VENTRICULAR SEPTAL DEFECT

VSD - isolated or part of complex congenital heart disease

VSD - most congenital defects are perimembranous (at junction of the membranous and muscular portions)

VSD - may be present as cardiac failure in infants (in the first 4-6 weeks of life), as a murmur with only minor hemodynamic disturbances in children or adults, as Eisenmenger's syndrome, sometimes may close spontaneously

PATHOPHYSIOLOGY:

- flow from the high-pressure left ventricle to the low pressure right ventricle (pansystolic murmur at the left sternal edge radiating all over the precordium)

- small defect - loud murmur (maladie de Roger), large defect - softer murmur (particulary if pressure in RV is elevated)

- Eisenmenger's syndrome -

• severe pulmonary hypertension (irreversible increased pulmonary resistance) due to an initial left-to-right shunt and reversal of the shunt - i.e. right-to-left shunting leads to central cyanosis, erythrocytosis and digital climbing,

• signs of pulmonary arterial hypertension (left parasternal-right ventricular lift, palpable pulmonary artery pulsation, loud P2, diastolic decrescendo murmur of pulmonic insufficiency (Graham Steell murmur), holosystolic murmur of tricuspid regurgitation

• CXR- enlarged central pulmonary arteries with peripheral pruning of the pulmonary vessels,

• ECG - right ventricular hypertrophy (more common in large VSD, persistent ductus arteriosus, ASD),

Category: Medicine Notes