Ventricular Septal Defect
A ventricular septal defect (VSD) is a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes. The membranous portion, which is close to the atrioventricular node, is most commonly affected in adults and older children.[1][2]Congenital VSDs are collectively the most common congenital heart defects.[3]
Diagnosis
A VSD can be detected by cardiac auscultation. Classically, a VSD causes a pathognomonic holo- or pansystolic murmur. Auscultation is generally considered sufficient for detecting a significant VSD. The murmur depends on the abnormal flow of blood from the left ventricle, through the VSD, to the right ventricle. If there is not much difference in pressure between the left and right ventricles, then the flow of blood through the VSD will not be very great and the VSD may be silent. This situation occurs a) in the fetus (when the right and left ventricular pressures are essentially equal), b) for a short time after birth (before the right ventricular pressure has decreased), and c) as a late complication of unrepaired VSD. Confirmation of cardiac auscultation can be obtained by non-invasive cardiac ultrasound (echocardiography). To more accurately measure ventricular pressures, cardiac catheterization, can be performed.
Signs and symptoms
Ventricular septal defect is usually symptomless at birth. It usually manifests a few weeks after birth.
Symptoms
Due to the cycling of the blood, from the lungs returning purified to the heart entering the left atrium passing down the valve to the left ventricle which has the defect resulting in the mixing of blood from the right and the left ventricle, the person can have signs of cynosis because the bloods strength in oxygen is low meaning that the blood supplied to the rest of the body is not fully oxygenated as the body needs it to be.[clarification needed]
Signs
- Pansystolic / Holosystolic murmur (depending upon the size of the defect)
Treatment
Treatment is either conservative or surgical. Smaller congenital VSDs often close on their own, as the heart grows, and in such cases may be treated conservatively. In cases necessitating surgical intervention, a heart-lung machine is required and a median sternotomy is performed. 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.Ventricular septum defect in infants is initially treated medically with cardiac glycosides (e.g., digoxin 10-20mcg/kg per day), loop diuretics (e.g., furosemide 1-3 mg/kg per day) and ACE inhibitors (e.g., captopril 0.5-2 mg/kg per day).
