Ventricular Septal Defect

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Ventricular Septal Defect

• hole in the septum between left and right ventricles usually producing a murmur

• congenital

• Commonest congenital heart lesion 

  • 2/1000 live births

• patient often young

Examination

• Introduction and exposure
• observation 
  • young 
  • generally well

    • if severe then heart failure at 6-8 weeks

• hands 
  • splinter haemorrhages (rare)
• pulse 
• blood pressure 
• neck 
• face 
• praecordium 
  • inspection 
  • palpitation 
    • apex undisplaced
    • systolic thrill at left sternal edge
  • auscultation 
    • pan-systolic murmur 
      • left sternal edge

      • may radiate to back

      • loud 'tearing'
      • heard well at apex
• lung bases 
• ankle oedema

Variants

• maladie de Roger

  • multiple small defects often close spontaneously

• Eisenmenger's Syndrome

  • increasing pulmonary artery pressure eventually leads to shunt reversal and child becomes cyanotic

Pathology

• left-to-right shunt

Investigations

• echocardiography

• arterial blood gases if cyanotic

Treatment

• antibiotic prophylaxis for invasive (e.g. dental) procedures as long as defect remains

• if small, no symptoms / complications (Maladie de Roger)
  • none required
• larger
  • cardiac catheterisation
  • surgical treatment

Prognosis

• small defects and maladie de Roger may close spontaneously during childhood

Complications

• Pulmonary hypertension

• Heart Failure

• Eisenmenger syndrome

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