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Ventricular Septal Defect (VSD)

by Brian Alverson, MD
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    00:01 This is absolutely the most common congenital heart defect, and that's a point of emphasis right there.

    00:08 The most common congenital heart defect is the VSD.

    00:12 This is simply a hole connecting the left and right ventricles.

    00:18 There are many different types of VSDs and it depends on where in the septum this little hole is.

    00:24 We have membranous VSDs that's about 75 percent of cases, that's just right through the membrane.

    00:31 Muscular VSDs.

    00:32 You may have a common AV Canal - we'll talk about that as a special case in a little bit.

    00:38 Or you may have a septum in the outlet between the aorta and the pulmonary artery.

    00:45 Generally, because the left side is higher pressures supplying those very high pressures to the body, the mixing lesions is going left to right.

    00:55 In patients with a VSD, often you'll hear a murmur.

    00:59 There's a couple of tricks to this murmur that you might not think of.

    01:04 Remember, the pitch of a murmur have to do with the size of the hole it goes through.

    01:10 Just like an organ, a very large pipe makes a low note.

    01:13 A very large VSD makes a lower pitched murmur than a very small VSD.

    01:19 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.

    01:28 These small VSDs will be high-pitched, very loud murmurs.

    01:33 This will eventually lead to congestive heart failure.

    01:39 The larger the lesion, the more likely you're going to end up in congestive heart failure.

    01:44 Those large lesions may have almost no murmur at all if it's the entire ventricle and it would be very low-pitched.

    01:51 Those can be sometimes tricky to hear.

    01:54 If these are left untreated, they can eventually lead to Eisenmenger's.

    01:59 Here on your slide, you can see a picture of a child with typical clubbing of the fingernails.

    02:05 This child has pulmonary disease from continuous overcirculation of their blood into the right side through their VSD.

    02:14 Eisenmenger's is when that right side is now higher pressure than the left - blood is now going right to left.

    02:21 This sort of patient would require a heart transplant and maybe even a heart-lung transplant if the lungs are bad enough.

    02:29 A VSD is repaired fortunately in most cases by itself.

    02:35 Many of these muscular and small defects will close on their own.

    02:38 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.

    02:44 Symptomatic patients will be treated with medications.

    02:48 Probably the most common medication we see used is Lasix or furosemide.

    02:54 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.

    03:04 Surgical repair is required in some of these children with very severe VSDs.

    03:09 Usually happens in the first year of life, they place a patch or sometimes, they'll have to do an open repair.

    03:16 That can be critical to ending this mixing which is really the primary problem.

    03:22 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.

    03:35 These patients are symptomatic very early.

    03:39 If you imagine, the heart is really just one big turbulent chamber of blood with mixing, These patients will often be cyanotic.

    03:48 Surgical correction is obviously needed.

    03:51 We need to rebuild these various septums, so that this child is capable of keeping the two sides of his heart apart.

    03:58 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.


    About the Lecture

    The lecture Ventricular Septal Defect (VSD) by Brian Alverson, MD is from the course Pediatric Cardiology.


    Included Quiz Questions

    1. Membranous
    2. Muscular
    3. Common AV canal
    4. Outlet septum
    5. Endocardial cushion defect
    1. Furosemide
    2. Amlodipine
    3. Amiodarone
    4. Propranolol
    5. No medication would help

    Author of lecture Ventricular Septal Defect (VSD)

     Brian Alverson, MD

    Brian Alverson, MD


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