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Ventricular Septal Defect

Title               

Ñ    Ventricular Septal Defect

Definition

Ñ    Defect in the interventricular septum

Ñ    Allowing communication

Ñ    Between the left and right ventricle

Aetiology

Ventricular septal defect may be:

Ñ    Congenital

Ñ    Acquired

Acquired VSD

Ñ    Myomalacia cordis:

Following myocardial infarction

Congenital Ventricular Septal Defect

Congenital ventricular septal defect may be:

Ñ    Isolated

Ñ    Associated with other cardiac defects

Ñ    Associated with somatic abnormalities

Isolated

Ñ    Ventricular septal defect may occur in isolation

Associated Cardiac Defects

Ventricular septal defect may be associated with cardiac defects such as:

Ñ    Syndromes in which the VSD is an integral part of the syndrome

Ñ    Syndromes in which VSD is not an integral part of the syndrome

Syndromes in which the VSD is an integral part of the syndrome

Ñ    Fallot’s tetralogy

Ñ    Truncus arteriosus

Ñ    Atrioventricular canal defects

Ñ    Double outlet right ventricle

Syndromes in which the VSD is not an integral part

Ñ    Patent ductus arteriosus

Ñ    Coarctation of the aorta

Ñ    Transposition of the great vessels

Ñ    Pulmonary atresia

Ñ    Tricuspid atresia

Somatic Abnormalities

Somatic abnormalities that are associated with VSD are:

Ñ    Down’s syndrome

Ñ    Turner’s syndrome

Pathophysiology

Ñ    Left ventricular pressure > right ventricular pressure:

Initially

Ñ    Left to right shunt

Ñ    Pulmonary blood flow increases

Ñ    Pulmonary vascular resistance increases

Ñ    Pulmonary hypertension develops

Ñ    Right ventricular hypertrophy occurs

Ñ    Right ventricular pressure increases

Ñ    With time right ventricular pressure > left ventricular pressure

Ñ    Shunt reverses:

Eisenmenger syndrome

Clinical Features

Ñ    Spontaneous closure may occur in a small VSD

Ñ    This usually occurs in childhood but may occur in adolescence and in adults

History

CVS

Ñ    Fatigue

Ñ    Dyspnoea

Examination

CVS

Ñ    Apex:

Displaced

Thrusting in nature

Ñ    Pan systolic murmur, left sternal edge

Ñ    Small defect:

The murmur may be shorter

Either early or late systolic

Ñ    Systolic click:

May occur if there is an aneurysm of the ventricular septum

Complications

CVS

Ñ    Subacute bacterial endocarditis

Ñ    Atrial fibrillation

Ñ    Aortic regurgitation

Ñ    Aneurysm of the ventricular septum

Ñ    Dilated ventricle

Ñ    Pulmonary hypertension

Ñ    Reversal of shunt:

Eisenmenger syndrome

Investigations

Imaging

Chest X-ray 

Ñ    Prominent pulmonary artery

Ñ    Pruning of pulmonary vessels:

If pulmonary hypertension develops

ECHO

Ñ    Demonstrates size and location of VSD

Electrophysiology

ECG

Ñ    Left and right ventricular hypertrophy

Physiological studies

Cardiac catheterisation

Ñ    Step up of oxygen saturation in right ventricle

Management

Cure

Surgery

Repair of defect (open surgery or percutaneous transcatheter closure) if there are:

Ñ    Symptoms

Ñ    Complications

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