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Large Ventricular Septal Defect


Presentation

  • Presently described is successful cesarean delivery in a pregnancy superimposed on long-term bosentan treatment in an Eisenmenger syndrome patient with cor triatriatum sinistrum, double-orifice mitral valve, and large ventricular septal defect resulting[ncbi.nlm.nih.gov]
  • Coronary artery anomalies were present in five patients, including one patient with a single left coronary artery. There was one early death (8%) in the only patient with a pulmonary artery band. There were no late deaths.[ncbi.nlm.nih.gov]
  • In all, 46.7% of patients with TBA and 30% of patients with TGA/VSD presented with sepsis secondary to pneumonitis and were taken for surgery when the infection was under control.[ncbi.nlm.nih.gov]
  • Abstract A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections[pediatrics.aappublications.org]
  • This diagnostic technique can be helpful when a patient presents after an acute myocardial infarction with pulmonary edema and shock to diagnose an acute ventricular septal defect.[healio.com]
Congestive Heart Failure
  • Nineteen infants with symptoms of congestive heart failure due to a VSD were studied with load-independent indexes during 4 study periods: (1) before any medication; (2) while on chronic diuretics; (3) while on both diuretics and digoxin; and (4) while[ncbi.nlm.nih.gov]
  • Abstract To evaluate the effect of acute vasodilator therapy, nitroprusside was administered at cardiac catheterization to five infants (ages 10 days to 6 months) with isolated ventricular septal defect and congestive heart failure.[ncbi.nlm.nih.gov]
  • Abstract A significant number of babies born with large ventricular septal defects present early in life as problems in management of congestive heart failure, severe pulmonary hypertension, marked growth retardation, and recurrent pulmonary infections[pediatrics.aappublications.org]
  • First, infants may have ongoing symptoms of congestive heart failure. Infants who have poor growth due to congestive heart failure can have poor brain development during the first few years of life.[cincinnatichildrens.org]
  • This may lead to congestive heart failure. Congestive heart failure does not mean the heart has failed or stopped; it means one or more chambers of the heart fail to keep up with the volume of blood flowing through them.[ucsfbenioffchildrens.org]
Atrial Septal Defect
  • Do you have a child between 30 days and 17 years old who will have elective surgery to close an atrial septal defect? This study tests a tool that allows surgeons to tell the difference between various types of heart tissue and avoid injury.[nhlbi.nih.gov]
  • septal defect ( Q21.1 ) Eisenmenger's defect ( Q21.8 ) patent ductus arteriosus ( Q25.0 ) ventricular septal defect ( Q21.0 ) Anomaly, anomalous (congenital) (unspecified type) Q89.9 ICD-10-CM Diagnosis Code Q89.9 Congenital malformation, unspecified[icd10data.com]
  • Additional cardiac lesions that increase left-to-right shunting (eg, atrial septal defect, patent ductus arteriosus, right heart obstructive lesions) may predispose patients to earlier development of CHF.[emedicine.medscape.com]
  • If your baby has a hole in the wall that separates the upper two chambers of the heart, she has an atrial septal defect. Find a Cardiothoracic Surgeon How Common Is VSD in Babies? VSD is the most common congenital heart defect in babies.[healthcare.utah.edu]
Sepsis
  • The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse.[ncbi.nlm.nih.gov]
  • In all, 46.7% of patients with TBA and 30% of patients with TGA/VSD presented with sepsis secondary to pneumonitis and were taken for surgery when the infection was under control.[ncbi.nlm.nih.gov]
Dyspnea
  • Large defects result in a significant left-to-right shunt and cause dyspnea with feeding and poor growth during infancy. A loud, harsh, holosystolic murmur at the lower left sternal border is common.[merckmanuals.com]
  • Endocarditis Heart failure Pneumonia Aortic insufficiency Right ventricular outflow obstruction Cardiogenic shock Pulmonary hypertension Possibly asymptomatic if the defect is small and isolated Dyspnea Cyanosis History of respiratory infections Excessive[quizlet.com]
  • Symptoms may include chest pain, difficulty breathing (dyspnea) after physical exertion, and episodes of fainting.[rarediseases.org]
Heart Disease
  • In: The clinical recognition of congenital heart disease. WB Saunders, Philadelphia, pp 396–439 Google Scholar 2. Ellis JH IV, Moodie DS, Sterba R, Gill CC (1987) Ventricular septal defect in the adult: Natural and unnatural history.[link.springer.com]
  • To participate in this study, you must be an adult with congenital heart disease with or without a family member with congenital heart disease. This study is located in Columbus, Ohio.[nhlbi.nih.gov]
  • WomenHeart is the first and only national patient-centered organization dedicated to serving women with heart disease. 48 Million American women living with or at risk for heart disease Over 900 WomenHeart Champions trained to be leaders and educators[womenheart.org]
  • Hendrick Health - Health Square - Congenital Heart Disease Online Handbook This web page contains a list of Congenital Heart Diseases.[childheartassociates.com]
  • Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.[medlineplus.gov]
Heart Murmur
  • The blood flowing through the hole creates an extra noise, which is known as a heart murmur. The heart murmur can be heard when a doctor listens to the heart with a stethoscope.[kidshealth.org]
  • This typically produces a noise called heart murmur. This heart murmur can be usually heard when the doctor listens your child chest with a stethoscope.[childheartspecialist.com]
  • Often the first sign of a Ventricular Septal Defect is the presence of an abnormal heart murmur.[stjoeshealth.org]
  • During a physical examination the doctor might hear a distinct whooshing sound, called a heart murmur. If the doctor hears a heart murmur or other signs are present, the doctor can request one or more tests to confirm the diagnosis.[cdc.gov]
  • Your provider will listen for a heart murmur with a stethoscope. A heart murmur is an extra sound heard between heartbeats. The murmur is caused by the abnormal flow of blood through the heart.[summitmedicalgroup.com]
Systolic Murmur
  • In the third and fourth intercostals space along the sternum a loud, rasping systolic murmur can be heard a long. This may not be the only finding of small defects.[remedyland.com]
  • systolic murmur Diagnostic Test Results-Imaging Chest X-rays may be normal in small defects; in large VSDs, they may show cardiomegaly, left atrial and left ventricular enlargement, and prominent pulmonary vascular markings.[quizlet.com]
  • With large defects allowing equalization of left ventricular and right ventricular pressures, the systolic murmur is often attenuated.[merckmanuals.com]
  • Auscultation : Click for Audio Example Systolic murmur : 3/6 low pitched, harsh holosystolic murmur best heard at lower sternal border in small defects; a 2/6 or louder, high pitched holsystolic murmur in moderate sized defects; and in large defects the[pedclerk.bsd.uchicago.edu]
  • A grade 2 to 5/6 systolic murmur is audible at the lower left sternal border. It may be pansystolic or early systolic.[patient.info]
Pansystolic Murmur
  • Classically, a VSD causes a pathognomonic holo- or pansystolic murmur. Auscultation is generally considered sufficient for detecting a significant VSD.[en.wikipedia.org]

Workup

  • (See Workup.) Perimembranous VSD is caused by failure of the endocardial cushions, the conotruncal ridges, and the muscular septum to fuse at a single point in space.[emedicine.medscape.com]
Right Axis Deviation
  • In those with pulmonary hypertension, right axis deviation, right ventricular hypertrophy (RVH) and right atrial hypertrophy (RAH) may be seen. CXR CXR is normal in patients with small VSDs.[patient.info]
Biventricular Hypertrophy
  • With large VSDs the ECG shows biventricular hypertrophy (BVH) with or without LAH. In those with pulmonary hypertension, right axis deviation, right ventricular hypertrophy (RVH) and right atrial hypertrophy (RAH) may be seen.[patient.info]
Right Atrial Hypertrophy
  • In those with pulmonary hypertension, right axis deviation, right ventricular hypertrophy (RVH) and right atrial hypertrophy (RAH) may be seen. CXR CXR is normal in patients with small VSDs.[patient.info]
Left Atrial Hypertrophy
  • With a moderate VSD, left ventricular hypertrophy (LVH) and occasionally left atrial hypertrophy (LAH) may be seen. With large VSDs the ECG shows biventricular hypertrophy (BVH) with or without LAH.[patient.info]

Treatment

  • The infant had no congenital cardiovascular abnormality or any probable teratogenic effect of bosentan treatment during pregnancy.[ncbi.nlm.nih.gov]
  • Abstract A total of 74 patients under 24 months of age with large ventricular septal defects (VSD) and pulmonary hypertension were subjected to surgical treatment from 1969 through 1975.[ncbi.nlm.nih.gov]
  • Long term future It is rare to need further treatment after surgery. Some patients will require medicines but this is usually only for a short time.[leedscongenitalhearts.com]
  • Treatment of VSD Treatment and management of a VSD depends on the size and specifics of the defect.[houstonmethodist.org]
  • However, some may require continuous treatment with diuretics and blood pressure medications to help the heart pump better. If there is a leak around the VSD patch, patients should continue to receive endocarditis prevention treatment.[ucsfhealth.org]

Prognosis

  • (See Epidemiology, Prognosis, and Treatment.)[emedicine.medscape.com]
  • Medical therapy in patients with Eisenmenger syndrome Pulmonary vasodilator therapy ( Nitric oxide ) Treatment prognosis: 25% of VSDs will close spontaneously by 2 years of life. References Frontera-Izquierdo, P., and Cabezuelo-Huerta, G. (1992).[pedclerk.bsd.uchicago.edu]
  • Children who have had larger holes closed at surgery have an excellent prognosis and in the long term fare well without symptoms leading normal lives.[childrensheartcentre.com]
  • Prognosis The prognosis for a patient with an isolated VSD is excellent. Most small-to-moderate muscular VSDs can be expected to close spontaneously.[patient.info]
  • The prognosis for patients whose VSDs either closed spontaneously or through surgery before the development of pulmonary vascular disease is excellent, with no exercise restrictions and normal life expectancy.[pted.org]

Etiology

  • (See Etiology.) Small VSDs (defined as VSD dimension less than half the size of the aortic annulus diameter) are usually isolated defects with otherwise normal cardiac anatomy and function.[emedicine.medscape.com]

Epidemiology

  • (See Epidemiology, Prognosis, and Treatment.)[emedicine.medscape.com]
  • Acquired VSD can occur as a result of a septal myocardial infarct but such a finding is much rarer than congenital lesions and prognosis tends to be poor. [ 2 ] Epidemiology [ 3 ] VSDs are the most common congenital heart defect in children, occurring[patient.info]
  • […] with potential placement of a local anesthetic infusion catheter under the fascia, to enhance postoperative pain control. j) Multiple muscular VSDs are a challenge to close, achieving a complete closure can be aided by the use of fluorescein dye. [15] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Pulmonary atresia with ventricular septal defect is characterized by underdevelopment of the right ventricular outflow tract with atresia of the pulmonary valve, a large VSD, and overriding of the aorta.[chw.org]
  • Pathophysiology Significant left to right shunting can occur resulting in a high left ventricular cardiac output. Forward systemic flow can be reduced if the shunt is large resulting in symptoms of congestive heart failure.[healio.com]
  • Pathophysiology [ edit ] During ventricular contraction, or systole, some of the blood from the left ventricle leaks into the right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium.[en.wikipedia.org]

Prevention

  • It is further anticipated that early correction of the septal defect will prove effective in many instances in preventing the serious consequences of pulmonary hypertension. Received April 12, 1966. Accepted June 23, 1966.[pediatrics.aappublications.org]
  • Medicines may be used temporarily to help with symptoms, but they don't cure the VSD or prevent permanent damage to the lung arteries.[heart.org]
  • As a matter of courtesy we request that the content provider (Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities) be credited and notified in any public or private usage of this image.[cdc.gov]
  • Every year, around 16,800 children are born with a ventricular septal defect, or VSD, in the US, according to the Centers for Disease Control & Prevention.[zofranlegal.com]
  • Other than avoiding these things during pregnancy, there is no known way to prevent a VSD. Images References Fraser CD, Carberry KE. Congenital heart disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.[ufhealth.org]

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