VENTRICULAR SEPTAL DEFECT.pptx

8/22/2019 VENTRICULAR SEPTAL DEFECT.pptx

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most common CHD(30%)

SYNONYMS* Rogers disease

* Interventricular septal defect


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Abnormal communication between two ventricle ( from left

to right ) 90 %defects are located in the membranous part of

ventricle


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typeI-MEMBRANOUS SEPTUM

typeII-MUSCULAR SEPTUM

typeIII-OUTLET SEPTUM deficient


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HEMODYNAMIC


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Pan-systolic murmur (in small VSD)

During ventricular systole

Left and right ventricles shows a pressure gradient

Pansystolic murmur

Masking the first heart sound andcontinues throughout systole with same intensity

At end of systole, closure of aortic valve

Pressure in both ventricles reaches same level

No pressure gradient is present

Murmur ends at the second heart sound


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Ejection systolic murmur

(in muscular VSD)

shunt from left to right across the VSD

More blood in right ventricle

More blood flow across pulmonary valve

Ejection systolic murmur

- Ejection systolic murmur cant be separated from pansystolic murmur


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Delayed diastolic murmur

Large amount of blood in right ventricle

Passing through the lungs

Blood finally reach left atrium increases left atrial enlargement

Large amount of blood passing normal mitral valve

Delayed diastolic murmur at apex

- Intensity and duration related to size of shunt (Large VSDs)


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Small VSD Large VSD

Smaller than aortic valve (up to 3mm)Symptoms:- Asymptomatic

Same size/ bigger than aortic valveSymptoms:-Heart failure with breathlessness

and failure to thrive after 1 week old- recurrent chest infectionPhysical signs:-May have thrill at lower sternal edge-Loud pansystolic murmur at lower

left sternal edge-Quiet pulmonary second sound

Physical signs:-Active pericodium-Soft pansystolic murmur

-Apical delayed-diastolic murmur-Loud pulmonary heart sound-Tachypnoea-Tachycardia-Enlarged liver from heart failure


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Small VSD Large VSDChest x-ray-Normal Chest x ray- Cardiomegaly

- Enlarged pulmonary arteries- increased plmonary vascular

markings- pulmonary edema

ECG:-Normal ECG:- Biventricular bypertrophy by 2

months of age and signs ofpulmonary hypertensionEchocardiogram- Demonstrates the precise anatomyof the defect

Echocardiogram- Demonstrates the anatomy of thedefects, haemodynamic effects and

severity of pulmonary hypertension


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CAT SCAN(Computed Axial Tomography)

MRI

ULTRASOUND

ANGIOGRAPHY

(cardiac catheterization and angiography)


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Small VSD Large VSD

-Will close spontaneously- when it present,

- maintain good dental

hygiene- antibiotics prophylaxisbefore dental extraction or anyoperation to prevent endocarditis.

-Drug therapy for heart failure diuretics with captopril- additional calories input

-Surgery performed at 3 6months:- manage heart failure- manage failure to thrive- prevent permanent lung damage


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Congestive cardiac failure

Infective endocarditis

Aortic insufficiency

Complete heart block Delayed growth & development (FTT) in infancy

Damage to electrical conduction system during

surgery(causing arrythmias) Pulmonary hypertensionEisenmengers

syndrome


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3 MAJOR TYPES SMALL (less than 3mm

diameter)- hemodynamically

insignificant

- b/w 80-85% of all VSDs- all close spontaneously

* 50% by 2yrs* 90% by 6yrs

* 10% during school yrs- muscular close sooner

than membranous


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MODERATE VSDs

* 3-5mm diameter

* least common group of children(3-5%)

* w/o evidence of ccf/ pulm.htn can befollowed until spontaneous closure occurs.

LARGE VSDs

* 6-10mm in diameter* usually requires surgery otherwise

develop CCF & FTT by age of 3-6mths.

Conservative treatment

- treat CCF & prevent development ofpulm.vascular disease

- prevention & treatment of infectiveendocarditis


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Thank you

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VENTRICULAR SEPTAL DEFECT.pptx