Paediatrics: Ventricular septal defect

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).