most common CHD(30%)

SYNONYMS

* Rogers disease * Interventricular septal defect

 Abnormal communication between two ventricle ( from left

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

typeI-MEMBRANOUS SEPTUM typeII-MUSCULAR SEPTUM typeIII-OUTLET SEPTUM deficient

HEMODYNAMIC

 Pan-systolic murmur (in small VSD)

During ventricular systole Left and right ventricles shows a pressure gradient Pansystolic murmur Masking the first heart sound and continues 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

 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

 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)

Small VSD

Large VSD

Smaller than aortic valve (up to 3mm) Same size/ bigger than aortic valve Symptoms: Symptoms: -Heart failure with breathlessness - Asymptomatic and failure to thrive after 1 week old - recurrent chest infection
Physical 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

Small VSD Chest x-ray -Normal

Large VSD Chest x ray - Cardiomegaly - Enlarged pulmonary arteries - increased plmonary vascular markings - pulmonary edema ECG: - Biventricular bypertrophy by 2 months of age and signs of pulmonary hypertension

ECG: -Normal

Echocardiogram Echocardiogram - Demonstrates the precise anatomy - Demonstrates the anatomy of the defects, haemodynamic effects and of the defect severity of pulmonary hypertension

 CAT SCAN

(Computed Axial Tomography)

MRI ULTRASOUND ANGIOGRAPHY

(cardiac catheterization and angiography)

Small VSD

Large VSD

-Will close spontaneously - when it present, - maintain good dental hygiene - antibiotics prophylaxis before dental extraction or any operation to prevent endocarditis.

-Drug therapy for heart failure diuretics with captopril - additional calories input -Surgery performed at 3 6 months: - manage heart failure - manage failure to thrive - prevent permanent lung damage

 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 hypertension Eisenmengers syndrome

 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

 MODERATE VSDs

* 3-5mm diameter * least common group of children(3-5%) * w/o evidence of ccf/ pulm.htn can be followed 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 of pulm.vascular disease - prevention & treatment of infective endocarditis

Thank you