Paediatrics: Ventricular septal defect

2021-03-05 12:00 AM

VSDs account for 25% of all CHD (2/1000 live births).

Ventricular septal defect

VSDs account for 25% of all CHD (2/1000 live births). They may occur in isolation or as part of complex malformations. The clinical features depend on the size and location of the defect.

Subtypes

  • Large/small VSD.
  • Perimembranous.
  • Muscular.
  • Multiple/small defects (maladie de Roger).

Clinical features

  • Asymptomatic (typical/early).
  • Heart failure (breathlessness—after the first few days of life).
  • Recurrent chest infections.
  • Cyanosis (rare after 1st decade of life)—s to Eisenmenger syndrome.
  • Endocarditis (late).

Examination 

Pansystolic murmur—lower left sternal edge parasternal thrill.

Prognosis 

The majority of defects will close spontaneously.

Management

  • Medical: treat heart failure if present.
  • Surgery: indicated if severe heart failure; pulmonary hypertension. This is performed at 3mths of age before pulmonary hypertension causes pulmonary vascular disease (Eisenmenger syndrome).