II. Epidemiology

  1. Incidence: 15-25% of Congenital Heart Disease
    1. Most common Congenital Heart Disease cause
    2. Most common CHD found in chromosomal abnormalities
  2. More common in males

III. Pathophysiology

  1. Defect in interventricular septal wall
    1. Most often located in membranous ventricular septum

IV. Signs and symptoms

  1. Severity of symptoms related to:
    1. Defect size
    2. Pulmonary vascular resistance
    3. Associated cardiac lesions
  2. Small to moderate VSD
    1. Normal P2 component of the Second Heart Sound
    2. Pansystolic harsh murmur
      1. Grade II-VI of VI
      2. Located at lower left sternal border
  3. Large VSD with significant shunt
    1. Includes moderate VSD findings
    2. Mid-diastolic flow rumble at apex
    3. Congestive Heart Failure signs and symptoms
  4. Marked Pulmonary Hypertension
    1. Right Ventricular lift
    2. Loud P2 component of the Second Heart Sound
    3. Short systolic ejection murmur at left sternal border

V. Radiology (large defect findings)

  1. Chest XRay
    1. Cardiomegaly
    2. Increased pulmonary vasculature
  2. Echocardiogram
    1. Defines position and size of defect

VI. Management: Medical

  1. Small Ventricular Septal Defect
    1. No surgical repair indicated
    2. SBE Prophylaxis
  2. Congestive Heart Failure
    1. Diuretics
    2. Digoxin

VII. Management: Surgical repair indications

  1. Growth failure refractory to medical therapy
  2. Pulmonary Hypertension
  3. Pulmonary to systemic flow ratio > 2:1

VIII. Course

  1. Spontaneous closure age <6 months: 30-40% related to:
    1. Membranous and muscular defects
    2. Smaller defects

IX. Complications: Without repair

X. Complications: With repair

  1. Conduction defect: transient Right Bundle Branch Block

XI. References

  1. Saenz (1999) Am Fam Physician 59(7):1857-66 [PubMed]
  2. Cyran (1998) PREP review lecture, October, Phoenix
  3. Merenstein (1994) Pediatrics, Lange

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