VENTRICULAR SEPTAL DEFECT

Pembimbing:
dr. Arlavinda Asmara Lubis, Sp. Rad(K). Onk rad
 Definition
A ventricular septal defect (VSD) is a hole or a defect in the septum that divides
the 2 lower chambers of the heart, resulting in communication between the
ventricular cavities.

A VSD may occur as a primary anomaly, with or without additional major

associated cardiac defects.

It may also occur as a single component of a wide variety of intracardiac

anomalies, including Tetralogy of Fallot, complete atrioventricular (AV) canal
defects, Transposition of great arteries, and corrected transpositions.

http://emedicine.medscape.com/article/892980-overview
VSD- Incidence & Prevalence

Second most common cardiac malformation after Bicuspid

aortic valve.

2-6/ 1000 live birth.

Isolated VSD in 20% of congenital cardiac anomalies

Coexists with other in 5% cases

Denotes a defect in IVS composed of muscular &

membranous segment
Anatomic positions of the defects:
Outlet defect (a)
Papillary muscle of the conus (b)
Perimembranous defect (c);
Marginal muscular defects (d);
Central muscular defects (e); Inlet
defect (f);
Apical muscular defects (g).
 Types
of VSD

Various types of ventricular

septal defects (VSDs) from the
right ventricular aspect. A =
Doubly committed subarterial
B = Perimembranous
C = Inlet or atrioventricular canal
type
D = Muscular ventricular septal
defect.
PATHOPHYSIOLOGY
 VSD- signs

blowing holosystolic murmur over

lower left sternal border(3rd/ 4th
ICS)
Displaced cardiac apex
S3 sound
Apical diastolic murmur
Pulmonary systolic murmur
Cardiac failure
 VSD
 Clinical Presentation
Depends on size of defect and magnitude of L-to-R
shunt
Ranges from asymptomatic patients to those
presenting with exertional dyspnea, cyanosis, chest
pain, syncope, and hemoptysis
On PE: asymptomatic to patients with poor growth
and CHF
 Differential Diagnosis
PDA
Pulmonary Stenosis
 VSD
 Laboratory Work-up
CXR
2D-Echo with Doppler – determine size and
location of virtually all VSDs
MRI – adjunct tool; used infrequently
Transesophageal Echocardiography (TEE) –
occasionally used; utilized in pediatric patients to
assess for completeness of repair
 VSD- CXR
VSD CXR

• Cardiomegaly and distinctly increased

vasculature strongly suggesting a left-to-right
shunt.
• There is also a suggestion of a left superior vena
cava which, in turn, may suggest an atrial septal
defect -- or it may be partial anomalous venous
return to the left superior vena cava.
 VSD
 Radiographic Findings
Enlarged LV and LA, along with RV
Increased pulmonary vasculature
RV size increases as PA pressure increases
Aorta normal in size
Heart is normal in size but is often enlarged
There may be LA enlargement resulting in
recognizable displacement of esophagus in lateral
projections
VSD- Echocardiography
HAEMODYNAMIC CLASSIFICATION
K.E.R
K.E.R
 TREATMENT
MK – K : Observation (once in a month) <1 yo
Observation (once in six months) >1 yo

MB – B : Use medication
- Digoxin
- Loop diuretic
- ACEi
 VSD
 Treatment
Surgery is not recommended for patients with normal
PA pressures with small shunts (pulmonary-to-
systemic flow ratios of <1.5 to 2.0: 1.0)
Operative correction or transcathether closure –
indicated when there is moderate L-to-R shunt
(pulmonary-to-systemic flow ratio > 1.5:1.0 or
2.0:1.0), in the absence of prohibitively high levels of
pulmonary vascular resistance
 VSD- complication

Failure to thrive
Rec. respiratory infection
Heart failure
Aortic regurgitation in supracristal VSD
Infective endocarditis
High PVR with reversal of shunt,
Eisenmenger physiology
Arrhythmia, subaortic stenosis
THANK YOU