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    22 Ventricular Septal Defect

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    dhiraj parmar
    Ventricular septal defect (VSD) is a common congenital heart defect where a hole exists in the wall separating the left and right ventricles of the heart. It can range from small to large. The most common type is a perimembranous VSD near the AV valve. Left-to-right shunting causes volume overload of the right ventricle and eventually pulmonary hypertension if large. Defects are usually repaired surgically during childhood before pulmonary pressures rise too high. Smaller defects may close on their own or be treated with medications and device closure becomes an option for some anatomies with muscular rims.

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    22 Ventricular Septal Defect

    Uploaded by

    dhiraj parmar
    298 views26 pages
    Ventricular septal defect (VSD) is a common congenital heart defect where a hole exists in the wall separating the left and right ventricles of the heart. It can range from small to large. The most common type is a perimembranous VSD near the AV valve. Left-to-right shunting causes volume overload of the right ventricle and eventually pulmonary hypertension if large. Defects are usually repaired surgically during childhood before pulmonary pressures rise too high. Smaller defects may close on their own or be treated with medications and device closure becomes an option for some anatomies with muscular rims.

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    Ventricular septal defect (VSD) is a common congenital heart defect where a hole exists in the wall separating the left and right ventricles of the heart. It can range from small to large. The most common type is a perimembranous VSD near the AV valve. Left-to-right shunting causes volume overload of the right ventricle and eventually pulmonary hypertension if large. Defects are usually repaired surgically during childhood before pulmonary pressures rise too high. Smaller defects may close on their own or be treated with medications and device closure becomes an option for some anatomies with muscular rims.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    298 views26 pages

    22 Ventricular Septal Defect

    Uploaded by

    dhiraj parmar
    Ventricular septal defect (VSD) is a common congenital heart defect where a hole exists in the wall separating the left and right ventricles of the heart. It can range from small to large. The most common type is a perimembranous VSD near the AV valve. Left-to-right shunting causes volume overload of the right ventricle and eventually pulmonary hypertension if large. Defects are usually repaired surgically during childhood before pulmonary pressures rise too high. Smaller defects may close on their own or be treated with medications and device closure becomes an option for some anatomies with muscular rims.

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    Ventricular septal

    defect (VSD)
    Definition
    • A defect in the septum that divides two ventricle of
    the heart, resulting in communication between the
    ventricular cavities.
    • Congenital acyanotic heart disease
    • The most common congenital cardiac anomaly.
    • It may be an isolated defect or part of a
    complex malformation.
    • Males and females are affected equally.
    Classification: Based on anatomical location

    a) A small membranous
    portion and

    b) A large muscular
    portion:
    a) The inlet septum,
    b) The outlet septum
    c) The trabecular
    septum:
    A. Perimembranous inlet
    (“AV canal-type”) VSD
    B. Perimembranous
    trabecular VSD
    C. Perimembranous
    infundibular
    VSD
    D. Inlet muscular
    VSD
    E. Trabecular
    muscular VSD
    F. Infundibular or outlet
    muscular VSD
    G. Subarterial infundibular
    Pathophysiology
    • Same as ASD
    Pathophysiology (cont)
    In moderate-to-large defects, a considerable shunt of
    oxygenated blood flows from the left to the right
    Ventricle
    ↓
    Volume overload and dilation of the right ventricle
    ↓
    The pulmonary annuli may dilate and become incompetent
    ↓
    Increased flow into the lungs
    ↓
    Pulmonary arteries, capillaries & the veins are dilated
    Pathophysiology (cont)
    Pulmonary arteries, capillaries & the veins are dilated
    ↓
    Flow-related pulmonary artery hypertension
    ↓
    Medial hypertrophy of pulmonary arteries and
    muscularization of the arterioles resulting in pulmonary
    vascular obstructive disease
    ↓
    Reversal of the shunt
    ↓
    Eisenmenger syndrome
    Clinical Features
    • Commonest congenital heart disease in children.
    • Detected due to presence of a murmur on routine
    examination.
    • Recurrent respiratory infections.
    • Failure to thrive.
    • Congestive heart failure.
    • Signs
    • Hyperdynamic precordium.
    • Systolic thrill at the third or fourth left intercostal
    space.
    • Pulmonary component of second sound normal or
    increased, depending upon the degree of elevation
    pulmonary artery pressure.
    • With the onset of pulmonary hypertension signs of pulmonary
    hypertension develop.
    • With the development of Eisenmenger's syndrome, central
    cyanosis and digital clubbing develop.
    Investigations
    • Same as ASD
    • Chest x-ray
    • Electrocardiogram (ECG)
    • Echocardiography
    • Cardiac catheterisation (if needed)
    Complications
    • Same as ASD
    Medical Management
    • Treatment of CHF:
     Rest
     O2 inhalation
     Diuretics
     Digoxin
     Vasodilators
    • Prophylaxis for infective endocarditis
    • No exercise restriction is required in the
    absence of pulmonary hypertension.
    Device closure
    • Trabecular VSDs have proved more amenable to this
    technique because of their relatively straightforward
    anatomy and a muscular rim to which the device
    attaches well and therefore results in excellent
    closure rates with low procedural mortality.

    • Closure of perimembranous VSDs is technically


    more challenging because of their proximity to
    valve structures.
    • The Amplatzer muscular VSD occluder consists of three
    components: an LV disk, a connecting waist, and an RV
    disk.
    • Polyester fabric is present in both disks and the
    connecting waist.
    Complications of Device closure
    • Device embolization
    • Arrhythmias
    • Air embolism
    • Hemolysis
    • Valvular regurgitation
    • Heart block
    Surgical closure
    •Indications:
    • A significant L-R shunt with Qp/Qs of greater
    than 1.5:1.
    • Surgery is not indicated for a small VSD with
    Qp/Qs less than 1.5:1.
    Timing of closure
    • Infants with CHF and growth retardation unresponsive
    to medical therapy should be operated on at any age,
    including early infancy.
    • Infants with a large VSD and evidence of increasing
    PVR should be operated on as soon as possible.
    • Infants who respond to medical therapy may be
    operated on by the age of 12 to 18 months.
    • Asymptomatic children may be operated on between 2
    and 4 years of age.
    Procedure
    • Direct closure of the defect is carried out under
    hypothermic cardiopulmonary bypass.
    • Most perimembranous and inlet VSDs are repaired
    by a transatrial approach.
    • Outlet (conal) defects are best approached through
    an incision in the main pulmonary artery.
    • Apical VSD may require apical right ventriculotomy.
    Transatrial repair of
    VSD
    Complications
    • Right bundle branch block
    • Complete heart block requiring pacemaker occurs
    in 1% to 2% of patients.
    • Residual shunt occurs in fewer than 5%.
    • The incidence of neurologic complications is
    directly related to the circulatory arrest time.
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