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Small VSD:
Defect smaller than the aortic valve in diameter, perhaps up to 3mm.
Clinical features:
Asymptomatic
May have thrill at lower sterna edge.
Loud pansystolic murmur at lower left sterna edge.
Quiet pulmonary second sound
Investigations:
1. Echocardiography
Demonstrates the precise anatomy of the defects.
It’s possible to assess it’s hemodynamic effects by Doppler echocardiograph
2. CXR & ECG
Normal, no findings.
Management:
Clinical features:
Heart failure with breathlessness and failure to thrive after 1 week old
Recurrent chest infections
Active precordium
Soft pansystolic murmur or no murmur
Apical mid-diastolic murmur- from increased flow across the mitral valve after blood has
circulated through the lungs.
Loud pulmonary second sound (P2) – due to raise pulmonary arterial diastolic pressure.
Investigation:
1. CXR
Cardiomegaly
Enlarged pulmonary arteries
Increased pulmonary vascular markings
Pulmonary oedema
2. ECG
Biventricular hypertrophy by 2months of age
Signs of pulmonary hypertension
3. Echocardiography
Demonstrates: anatomical defects, haemodynamic effects and severity of pulmonary
hypertension.
Management:
This pulmonary vascular disease usually becomes established in the second year of life.
But, Eisenmenger’s syndrome with cyanosis due to intracardiac shunting from right to left, rarely evolves
until the second decades.
Prognosis:
Except in the case of Eisenmenger’s syndrome, which many patients die in the second or third decade of
life.