Professional Documents
Culture Documents
Most
common
(15-20%) defects
of
all (not
congenital
heart
part of
VSD involving membranous septum also involves the adjacent muscular area peri-membranous VSD (70% of all VSDs). Muscular VSD can be inlet, outlet or trabecular defect.
Clinical Features
HISTORY
Small VSD
Asymptomatic
Clinical Features
Low exercise tolerance Repeated chest infections CHF during infancy Longstanding VSD
PAH Cyanosis + low level of activity
Clinical Features
PHYSICAL EXAMINATION
Clinical Features
Reversal of shunt cyanosis and clubbing. Systolic border thrill at left lower sternal
INVESTIGATIONS
CXR
Cardiomegaly (LA, LV sometimes RV) Increased Pulmonary vascular markings. In POVD
INVESTIGATIONS
ECG
Small VSD: Moderate VSD: Large defect: In POVD: ECG is normal LVH, occ LAH BVH RVH only.
Echo
Diagnostic.
NATURAL HISTORY
During decrease
1st in
months and
of
life,
VSDs close
size
30-40%
NATURAL HISTORY
Infective Endocarditis is rare. POVD begins to develop by 6-12 mnths of age but R-L Shunt does not develop until teenage years.
MANAGEMENT
Medical No exercise restriction in the absence of PAH. Prophlaxis for IE needed. CHF is treated with diuretics and digoxin. Potassium sparing diuretics may be added. Frequent feeding with high calorie formulae. Anaemia should be corrected.
MANAGEMENT
Surgical Management Infants with small VSD and have reached 6 months of age without CCF or PAH No surgery needle. Indication for surgery Infants with large VSD who developed CHF and growth failure not respiratory to medical management. Surgery indicated within 6 months of age.
MANAGEMENT
Surgical Management Pulmonary artery pressure > 50% of systemic pressure VSD to be operated within 1st year of age. After one year of age Pulmonary flow: Systemic flow > 2:1. Older infants with large VSD and evidence of PAH should be operated as soon as possible. Infants with evidence of PAH but not CHF or growth failure should have cardiac catheterization at 6-12 months of age followed by surgery.
MANAGEMENT
Contraindications for Surgery