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A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). The ventricular septum consists of a muscular (inferior) and membranous portion (superior). The membranous portion (which is close to the atrioventricular node) is most commonly affected. Congenital VSDs are collectively the most common congenital heart defect.
Diagnosis VSDs can be detected by cardiac auscultation, as they typically cause systolic murmurs. Confirmation of findings from cardiac auscultation can be obtained with a cardiac ultrasound (echocardiography) (less invasive) and cardiac catheterization (more invasive). Auscultation is generally considered sufficient for ruling-out a significant VSD, if done by a pediatric cardiologist. This holds true as long as the pressures on the right side of the heart is low. Pathophysiology The blood from the left ventricle flows across the defect into the right ventricle during ventricular contraction ( systole) and enters the pulmonary artery into the lungs where it returns to the left heart via the pulmonary veins into the left atrium and left ventricle. Hence there is volume loading of the left sided heart chambers in patients with significant defect. There is increased in the workload and congestion of the lung vessels in large defects. The pulmonary pressure is increased in large defects ( pulmonary hypertension) Most patients with large defect present with breathlessness, poor feeding and failure to thrive in infancy. Patients with small defects are asymptomatic. Treatment Treatment is either surgical (open or percutaneous endovascular) or conservative. Smaller congenital VSDs often close on their own (as the heart grows) and are thus treated conservatively. Open surgical procedures require a heart-lung machine and are done with a median sternotomy. Percutaneous endovascular procedures are less invasive and can be done on a beating heart, but are only suitable for certain patients. Repair of most VSDs is complicated by the fact that the conducting system of the heart is in the immediate vicinity. Epidemiology VSDs are the most common congenital cardiac anomalies. They are found in 30% of all newborns with a congenital heart defect, or about 2-3 per 1000 births. Congenital VSDs are frequently associated with other congenital conditions, such as Down syndrome. A VSD can form a few days after a myocardial infarction (heart attack) due to mechanical tearing of the septal wall, before scar tissue forms, when macrophages start remodeling the dead (heart) tissue. See also | |||||||||||||||||||||||||||
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