Ventricular septal defect

From Wikipedia, the free encyclopedia

**Ventricular septal defect**
*Classifications and external resources*

Echocardiographic image of a moderate ventricular septal defect in the mid-muscular part of the septum. The trace in the lower left shows the flow during one complete cardiac cycle and the red mark the time in the cardiac cycle that the image was captured. Colours are used to represent the velocity of the blood. Flow is from the left ventricle (right on image) to the right ventricle (left on image).
ICD-10	Q 21.0
ICD-9	745.4
DiseasesDB	13808
MeSH	C14.240.400.560.540

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.^[1]^[2]

Congenital VSDs are collectively the most common congenital heart defect.^[3]

diagram of a healthy heart and one with VSD

1 Diagnosis
2 Pathophysiology
3 Treatment
4 Epidemiology
5 See also
6 References
7 External links

[edit] Diagnosis

VSDs can be detected by cardiac auscultation, as they typically cause pan-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.^[4] This holds true as long as the pressures on the right side of the heart is low.

[edit] 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.

[edit] Treatment

A nitinol device for closing muscular VSDs, 4 mm diameter in the centre. It is shown mounted on the catheter into which it will be withrawn during insertion.

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.

[edit] 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.^[5]

A VSD can form a few days after a myocardial infarction^[6] (heart attack) due to mechanical tearing of the septal wall, before scar tissue forms, when macrophages start remodeling the dead (heart) tissue.

[edit] See also

[edit] References

^ Ambumani P, Kuruchi Srinivasan. Ventricular Septal Defect, General Concepts. eMedicine.com. URL: http://www.emedicine.com/ped/topic2402.htm. Accessed on December 5, 2005.
^ Eidem BW. Ventricular Septal Defect, Muscular. eMedicine.com. URL: http://www.emedicine.com/ped/topic2543.htm. Accessed on April 13, 2006.
^ Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900. PMID 12084585.
^ Geva T, Hegesh J, Frand M. Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory? Int J Cardiol. 1988 Apr;19(1):107-13. PMID 3372064.
^ Wells GL, Barker SE, Finley SC, Colvin EV, Finley WH. Congenital heart disease in infants with Down's syndrome. South Med J. 1994 Jul;87(7):724-7. PMID 8023205.
^ Bruckheimer E. Ventricular septal defect. Medical Encyclopedia - MedlinePlus.org, URL: http://www.nlm.nih.gov/medlineplus/ency/article/001099.htm. Accessed on December 5, 2005.