This is absolutely the most common congenital heart defect,
and that's a point of emphasis right there.
The most common congenital heart defect is the VSD.
This is simply a hole connecting the left and right ventricles.
There are many different types of VSDs
and it depends on where in the septum this little hole is.
We have membranous VSDs that's about 75 percent of cases,
that's just right through the membrane.
You may have a common AV Canal -
we'll talk about that as a special case in a little bit.
Or you may have a septum in the outlet
between the aorta and the pulmonary artery.
Generally, because the left side is higher pressures
supplying those very high pressures to the body,
the mixing lesions is going left to right.
In patients with a VSD, often you'll hear a murmur.
There's a couple of tricks to this murmur
that you might not think of.
Remember, the pitch of a murmur
have to do with the size of the hole it goes through.
Just like an organ, a very large pipe makes a low note.
A very large VSD makes a lower pitched murmur than a very small VSD.
They tend to be very loud when they're smaller
because it's a very turbulent jet of blood
cruising right through from the left to the right.
These small VSDs will be high-pitched, very loud murmurs.
This will eventually lead to congestive heart failure.
The larger the lesion,
the more likely you're going to end up in congestive heart failure.
Those large lesions may have almost no murmur at all
if it's the entire ventricle and it would be very low-pitched.
Those can be sometimes tricky to hear.
If these are left untreated, they can eventually lead to Eisenmenger's.
Here on your slide, you can see a picture of a child
with typical clubbing of the fingernails.
This child has pulmonary disease from continuous overcirculation
of their blood into the right side through their VSD.
Eisenmenger's is when that right side
is now higher pressure than the left -
blood is now going right to left.
This sort of patient would require a heart transplant
and maybe even a heart-lung transplant if the lungs are bad enough.
A VSD is repaired fortunately in most cases by itself.
Many of these muscular and small defects will close on their own.
So, if it's a very small defect,
it's likely not causing too much trouble for the child,
keep an eye on that child.
Symptomatic patients will be treated with medications.
Probably the most common medication we see used
is Lasix or furosemide.
Furosemide allows those lungs to diurese a little bit
and have a little bit less wetness
which allows the breathing to be a little bit easier.
Surgical repair is required in some of these children
with very severe VSDs.
Usually happens in the first year of life,
they place a patch
or sometimes, they'll have to do an open repair.
That can be critical to ending this mixing
which is really the primary problem.
Let's look at the worst VSD that you can imagine
and that is both the VSD and an ASD
and we call this the common A-V canal
or endocardial cushion defect.
These patients are symptomatic very early.
If you imagine, the heart is really just one big turbulent chamber
of blood with mixing,
These patients will often be cyanotic.
Surgical correction is obviously needed.
We need to rebuild these various septums,
so that this child is capable of keeping the two sides of his heart apart.
And what is a high yield fact on this one
is that the most common defect in patients with Down syndrome
is the common A-V canal
Remember, the most common defect overall in congenital heart disease is the VSD,
but the most common defect in patients with Down syndrome
is the common A-V canal.