Ventricular septal defect

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A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. The ventricular septum consists of an inferior muscular and superior

Ventricular septal defect
Classification and external resources

Echocardiographic image of a moderate ventricular septal defect in the mid-muscular part of the septum. The trace in the lower left shows the flow during one complete cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colours are used to represent the velocity of the blood. Flow is from the left ventricle (right on image) to the right ventricle (left on image). The size and position is typical for a VSD in the newborn period. ICD-10 ICD-9 Q21.0 (http://apps.who.int/classifications/apps/icd/icd10online/?gq20.htm+q210) 745.4 (http://www.icd9data.com/getICD9Code.ashx?icd9=745.4)

DiseasesDB 13808 (http://www.diseasesdatabase.com/ddb13808.htm) eMedicine MeSH med/3517 (http://www.emedicine.com/med/topic3517.htm) C14.240.400.560.540 (http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi? mode=&term=Ventricular+Septal+Defects&field=entry#TreeC14.240.400.560.540)

membranous portion and is extensively innervated with conducting cardiomyocytes. The membranous portion, which is close to the atrioventricular node, is most commonly affected in adults and older children.[1][2] Muscular ventricular septal defect is the most common type, and may lie in four locations: anterior, midventricular, posterior, apical[3] Congenital VSDs are collectively the most common congenital heart defects.[4]
Ventricular septal defect

Pathophysiology During ventricular contraction.or pansystolic murmur. then the flow of blood through the VSD will not be very great and the VSD may be silent. Faults with NKX2. with perimembranous most common. It usually manifests a few weeks after birth.[5] Signs and symptoms Ventricular septal defect is usually symptomless at birth. atrioventricular. Heart sounds are normal.5 gene can cause this. et al. First. Treatment . causing pulmonary hypertension with its associated symptoms. poor feeding and failure to thrive in infancy. as the heart enlarges).Diagnosis A VSD can be detected by cardiac auscultation. who may present with breathlessness. so there are no signs of cyanosis. passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium. through the VSD.palpable thrill (palpable turbulence of blood flow). the circuitous refluxing of blood causes volume overload on the left ventricle. Second. Symptoms VSD is an acyanotic congenital heart defect. Elsevier 2006]. to the right ventricle. Patients with smaller defects may be asymptomatic. because the left ventricle normally has a much higher systolic pressure (~120 mm Hg) than the right ventricle (~20 mm Hg). If there is not much difference in pressure between the left and right ventricles. CAUSES: The cause of VSD ( ventricular septal defect) includes the incomplete looping of the heart during days 24-28 of development. p116-117 eds Cameron P. outlet. aka a Left-to-right shunt. a displaced apex beat (the palpable heartbeat moves laterally over time. Confirmation of cardiac auscultation can be obtained by non-invasive cardiac ultrasound (echocardiography). Auscultation is generally considered sufficient for detecting a significant VSD. some of the blood from the left ventricle leaks into the right ventricle. Four different septal defects exist. An infant with a large VSD will fail to thrive and become sweaty and tachypnoiec (breathe faster) with feeds [Textbook of Paediatric Emergency Medicine. and muscular less commonly. Classically. Signs ■ Pansystolic (Holosystolic) murmur (depending upon the size of the defect) +/. cardiac catheterization. can be performed. This effect is more noticeable in patients with larger defects. The murmur depends on the abnormal flow of blood from the left ventricle. To more accurately measure ventricular pressures. This has two net effects. and c) as a late complication of unrepaired VSD. This situation occurs a) in the fetus (when the right and left ventricular pressures are essentially equal). b) for a short time after birth (before the right ventricular pressure has decreased). or systole. a VSD causes a pathognomonic holo. Larger VSDs may cause a parasternal heave. the leakage of blood into the right ventricle therefore elevates right ventricular pressure and volume.

Most cases don't need treatment and heal at the first years of life. e) Critical attention is necessary to avoid injury to the conduction system located on the left ventricular side of the interventricular septum near the papillary muscle of the conus. Smaller congenital VSDs often close on their own. captopril 0. PTFE (Goretex(tm) or Impra(tm).5–2 mg/kg per day).. Large VSD with pulmonary hypertension 4. Surgical technique for Repair of Perimembranous VSD a) Surgical closure of a Perimembranous VSD is performed on cardiopulmonary bypass with ischemic arrest. c) Several patch materials are available.e. . i. f) Care is taken to avoid injury to the aortic valve with sutures. bovine pericardium. including native pericardium.g. Some cases may necessitate surgical intervention. the heart is extensively deaired by venting blood through the aortic cardioplegia site. and by infusing Carbon Dioxide into the operative field to displace air.g. Repair of most VSDs is complicated by the fact that the conducting system of the heart is in the immediate vicinity. loop diuretics (e. Percutaneous Device closure of these defects is rarely performed in the United States because of the reported incidence of both early and late onset complete heart block after device closure. and in such cases may be treated conservatively. Failure of congestive cardiac failure to respond to medications 2. presumably secondary to device trauma to the AV node. d) Suture techniques include horizontal pledgeted mattress sutures. Percutaneous endovascular procedures are less invasive and can be done on a beating heart. or dacron. Patients are usually cooled to 28 degrees. A nitinol device for closing muscular VSDs. with the following indications: 1. 4 mm diameter in the centre. The tricuspid valve septal leaflet is retracted or incised to expose the defect margins. Treatment is either conservative or surgical. digoxin 10-20mcg/kg per day). as the heart grows. It is shown mounted on the catheter into which it will be withdrawn during insertion. a heart-lung machine is required and a median sternotomy is performed. and running polypropylene suture.. VSD with pulmonic stenosis 3. g) Once the repair is complete. but are only suitable for certain patients.. VSD with aortic regurgitation For the surgical procedure. Ventricular septum defect in infants is initially treated medically with cardiac glycosides (e. b) Surgical exposure is achieved through the right atrium. furosemide 1–3 mg/kg per day) and ACE inhibitors (e.g.

and the daily postoperative recovery. with potential placement of a local anesthetic infusion catheter under the fascia. when the heart begins life as a hollow tube. They are found in 30-60% of all newborns with a congenital heart defect.[7][8] Congenital VSDs are frequently associated with other congenital conditions. since most of the trabecular VSDs close spontaneously. when macrophages start remodeling the dead heart tissue.[9] A VSD can also form a few days after a myocardial infarction[10] (heart attack) due to mechanical tearing of the septal wall. or about 2-6 per 1000 births. See also ■ ■ ■ ■ ■ ■ Atrial septal defect Atrioventricular septal defect Cardiac output Congenital heart disease Heart sounds Pulmonary hypertension Additional images ■ .youtube. i) The sternum.h) Intraoperative transesophageal echocardiography is used to confirm secure closure of the VSD. forming a septa. If this does not occur properly it can lead to an opening being left within the ventricular septum. fascia and skin are closed. good ventricular function. j) A video of Perimembranous VSD repair. During heart formation. before scar tissue forms. normal function of the aortic and tricuspid valves.com/watch?v=Uf_tRlG1nMc) Epidemiology and Etiology VSDs are the most common congenital cardiac anomalies. including the operative technique. Perimembranous Ventricular Septal Defect (http://www. it begins to partition. and the elimination of all air from the left side of the heart. It is debatable whether all those defects are true heart defects. or if some of them are normal phenomena. such as Down syndrome. can be seen here: VSD Repair. to enhance postoperative pain control.[6] Prospective studies give a prevalence of 2-5 per 100 births of trabecular VSDs that closes shortly after birth in 80-90% of the cases.

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