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Virtual Pediatric Hospital: Paediapaedia: Ventricular Septal Defect (VSD) Paediapaedia: Cardiovascular Diseases

Ventricular Septal Defect (VSD)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
This is the most frequent congenital heart disease causing congestive heart failure in infancy. It is usually not detected until 1 month of age when the normal physiologic decrease in pulmonary vascular resistance allows left to right shunting to begin. The incidence of congenital heart disease is 0.7-1% of all live births, with VSD being the most common congenital heart disease, accounting for 20-25% of all CHD. VSD can occur along, or as a component of a more complex cardiac defect.

Etiology/Pathophysiology:
There are 4 locations for VSD - supracrystal, membranous (the most common - 80%), endocardial cushion type (posterior), and muscular. The amount of hemodynamic disturbance associated with a VSD depends on the size of the VSD and the pulmonary vascular resistance. Eisenmenger's physiology is when the pulmonary vascular resistance exceeds the systemic resistance and there is a reversal of a left to right shunt to a right to left shunt. After a left to right shunt develops the left atrium and left ventricle dilate to accomodate the increased pulmonary venous return. Fifty percent of cases spontaneously close by 3 years of age.

Pathology:
Not applicable

Imaging Findings:
Depends on the size of the shunt. Small VSDs have normal chest films. Moderate or large VSDs with low pulmonary vascular resistance have prominent shunt vascularity, with left atrial and ventricular dilation.

Left atrial enlargement is evidenced by a bulge that elevates the left bronchus, a double density along the right heart border, and a posterior indentation of a barium filled esophagus.

Signs of pulmonary hypertension include pruned tree pulmonary vascularity and right ventricular dilation.

DDX:

References:
See References Chapter.

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