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Ventricular Septal Defectjpg
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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)
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Ventricular+Septal+Defects
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A (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.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.
Congenital VSDs are collectively the most common
Congenital Heart Defect .Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900. PMID 12084585.
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.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. This holds true as long as the pressures on the right side of the heart is low.
Large VSDs result in a significant left-to-right shunt and increase load on the right ventricle. If untreated, they result in
Hypertrophy of the right ventricle, which ultimately leads to right
Heart Failure and
Death .
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.
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 .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.
A VSD can form a few days after a wall, before
Scar Tissue forms, when
Macrophage s start remodeling the dead (heart) tissue.
