CAUSATION

(VSD)

It is commonest cardiac malformation at birth (1 in 500 live births.)

Due to defect in the ventricular septum blood from the left ventricle (which is a high pressure chamber) goes to the right ventricle (which is a low pressure chamber). Thus left atrium and both ventricles are hypertrophied and pulmonary hypertension soon develops. In course of time the direction of shunt is reversed, called Eisenmenger’s complex.Small defect is called Maladic de Roger.

VSD may be acquired from trauma or septal infraction.

TYPES:

1. Perimembranous or infracristal or subaortic is the commonest type.
2. Supracristal or Subpulmonic.
3. Canal type or AV septal defect.
4. Muscular type.

FEATURES:VENTRICULAR SEPTAL DEFECT

1. Usually no symptoms , till second or third decade.
2. When symptoms are present they include breathlessness, fatigue, cardiac failure, features of Bacterial endocarditis, etc.
3. Biventricular enlargement.
4. A systolic thrill over the lower left sterna edge.
5. A holosystolic flow murmur (Grade II-VI/VI) over the same area with accentuated S1. A small defect mat produce a loud murmur while a large defect may have a soft murmur.
6. A mid-diastolic flow murmur over the mitral area.
7. Wide splitting of S2 with accentuated P2. Loud S3.
8. Aortic incompetence may develop in large VSD either from the aortic valve abnormality or due to herniation of aortic valve in presence of high defect.
9. Radiological and electro-cardiographic examinations may reveal no abnormality in small defects. With large defects there may be evidence of biventricular enlargement and the defect itself. MRI will visualize the septal defect. Radio-nuclide flow studies will qualified thr pulmonary to systemic flow ratio. Definite diagnosis can be made by catheterization.

TREATMENT:

By one heart surgery or by-pass techniques this defect can be repaired. When the defect is small no operation is needed. Sometimes small defect may close spontaneously (<10%). In presence of increased pulmonary vascular resistance operation is contraindicated. Surgical mortality is 2-5% for primary repair.

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VENTRICULAR SEPTAL DEFECT