Ventricular Septal Defect

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Ventricular Septal Defect (VSD) is a congenital heart defect characterised by an abnormal opening or hole in the septum, separating the ventricles of the heart. This wall, known as the ventricular septum, ensures that blood rich in oxygen (in the left ventricle) and blood poor in oxygen (in the right ventricle) do not mix.

A VSD permits blood to flow between the ventricles, causing oxygen-rich blood from the left ventricle to mix with oxygen-depleted blood from the right ventricle. This causes additional blood to be pumped to the lungs, leading to an increase in the heart and pulmonary arteries' workload and pressure.

• Genetic factors: down syndrome, Turner syndrome and DiGeorge syndrome.

• Certain medications: angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and some antiepileptic drugs.

• Maternal infections.

• Maternal consumption of alcohol or drug abuse.

• Maternal gestational diabetes and poorly controlled.

The pathophysiology of ventricular septal defects (VSDs) revolves around the abnormal communication between the left and right ventricles caused by a hole in the ventricular septum. This communication disrupts the normal blood flow within the heart, resulting in a left-to-right shunt that causes the oxygen-rich blood in the left ventricle to mix with the oxygen-poor blood in the right ventricle.

• Premature birth.

• Low birth weight.

• Maternal infections during pregnancy.

• Family history of congenital heart defects.

• The signs and symptoms of VSD in infants may include 

• rapid breathing (tachypnoea)

• poor feeding and failure thrive

• Heart murmur on physical examination pansystolic murmur can be heard on the left sternal edge of the chest.

• CXR cardiomegaly may be observed.

• Cardiac MRI.

• echocardiogram (diagnostic).

• electrocardiogram (ECG).

• Cardiac catheterisation (rarely used).

• In mild cases, no intervention is needed and monitoring up until 1 year old.

• If a child is born prematurely IV NSAID can be administered.

• If the hole is still open surgery can be performed.

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