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Common Congenital Heart Lesions - page 4 / 126





4 / 126

4 of 126

2. Ventricular Septal Defect

Clinical Presentation: small VSD= no symptoms, large VSD= presents in infants as CHF (tachypnea, poor feeding, failure to thrive, frequent lower respiratory tract infections). Presents with dyspnea and cyanosis if accompanied by increased pulm vascular resistance. Bacterial endocarditis

Physical Findings:

  • 1.

    Harsh holosystolic murmur, best heard at left sternal border. Smaller defects have LOUDER murmurs. **Unlike ASD, murmur results from blood going through defect.

  • 2.

    systolic thrill over murmur

  • 3.

    mid-diastolic rumble at the apex (increased flow over mitral valve)

  • 4.

    With increased pulm vascular resistance: holosystolic murmur diminishes, RV heave, loud P2 closure, cyanosis

Diagnostic Imaging and Testing:

  • A.

    Chest radiograph: small VSD= normal cardiac silhouette, large VSD= cardiomegaly and prominent vascular markings. If Pulm Vascular Resistance, than enlarged pulmonary arteries with peripheral tapering

  • B.

    ECG: If large shunt, LA enlargement and LVH are present. If Pulm vascular disease develops, then add RVH

  • C.

    Echo+ Doppler: location of VSD, direction and magnitude of shunt, estimate RV pressure

  • D.

    Cardiac Cath: increased O2 in RV

Treatment: spontaneous closure in 50% of patients with small and medium VSD’s, surgical closure recommended within first few months of life if patient has CHF or pulmonary vascular disease. If patient has moderate-sized VSD but no Pulm Vascular Disease, then surgical closure can wait until later in childhood. Give prophylactic treatment for endocarditis for all VSD patients.

Etiology: abnormal opening in interventricular septum, 70% in membranous, 20% muscular, 10% below aortic valve or near AV valves

Pathology: hole in interventricular septum, dilation of RV, PA, LA, LV

Pathophysiology: depends on size of defect and relative resistances of pulmonary and systemic vasculature. Left to right shunt. If shunt is large, volume overload occurs in RV, pulm circulation, LA and LV, resulting in increased stroke volume. Over time, volume overload causes chamber dilatation, systolic dysfunction, and heart failure. Increase in pulm vascular resistance causes Eisenmenger syndrome Epidemiology: common (2-4/1000)

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