Ventricular Septal Defect (VSD) CLINICAL FEATURES General examination with Treatment
- There is a shunt from LV to RV due to a defect in the interventricular septum.
- VSD also occurs in combination with other congenital heart defects, as in an atrioventricular canal (AVC),transposition of the great arteries (D-TGA),tetralogy of Fallot (TOF) and occasionally,
- Presentation — Most infants with VSD present in the neonatal period.
- typical presentation of a small VSD in a neonate involves the detection of a cardiac murmur at four to ten days of life
General examination —
- Infants with small, restrictive VSDs usually remain asymptomatic.
- These include Tachypnea (from increased pulmonary blood flow) Poor feeding (appears hungry but tires easily;
- In contrast, infants with moderate to large VSDs usually manifest signs of heart failure by three to four weeks of age ,
- Tachycardia Hepatomegaly Pulmonary rales, grunting, and retractions (if heart failure is marked) Pallor (from peripheral vasoconstriction)
- sweats with feeds) Poor weight gain (prolonged and severe failure may also affect linear growth and head circumference)
Mild / Small VSD :
- Very small peri membranous and muscular ventricular septal defects may be undetected. There may be normal pulmonary arterial pressure.
- There is a prominent left parasternal holosystolic murmur. The murmur may disappear as the defect may spontaneously close.
Moderate VSD :
- There may be congestive heart failure with holosystolic murmurs in the infant.
Large VSD :
- There is failure to thrive, retarded growth and development, hyperdynamic left ventricular impulse, left parasternal heave and thrill, harsh holosystolic murmur and apical mid diastolic murmur across the mitral valve.
- Peri membranous or small VSD closes spontaneously. With moderate and large VSD pulmonary vascular resistance increases, there may be congestive heart failure but always there is marked progressive pulmonary vascular disease.
- There is prominent left ventricular impulse due to volume overload and parasternal heave due to dilated right ventricule due to increased pulmonary vascular resistance.
- VSDs lie just beneath the aortic valve and behind the septal leaflet of the tricuspid valve
- There is systolic thrill and holosystolic murmur, loud P2 and apical mid-diastolic murmur.
- Shows left atrial ‘P’ wave and tall T waves, or biatrial P waves and biventricular hypertrophy.
- Shows increased pulmonary vascularity and pulmonary venous congestion. There is cardiomegaly with dilatation of all chambers.
- In moderate to large defects with increased left-to-right shunts, the pulmonary vascular markings are increased, and the left atrium, LV, and PA may be enlarged.
- Later on there is decreased pulmonary blood flow, reversal of shunt (right to left) – Eisenmenger physiology.
- In small defects, the radiograph is usually normal.
- All four chambers as well as the pulmonary trunk are dilated but aortic root is small.
- Shows the ventricular septal defect.
- Two-dimensional and Doppler echocardiography are useful in identifying the location of the defect and estimating the size of the shunt
Treatment of VSD
- Surgical or non-surgical closure of the defect at appropriate age before pulmonary hypertension develops and reversal of shunt (right to left) occurs.