VENTRICULAR SEPTAL DEFECT.pptx
Transcript of VENTRICULAR SEPTAL DEFECT.pptx
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most common CHD(30%)
SYNONYMS* Rogers disease
* Interventricular septal defect
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Abnormal communication between two ventricle ( from left
to right ) 90 %defects are located in the membranous part of
ventricle
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typeI-MEMBRANOUS SEPTUM
typeII-MUSCULAR SEPTUM
typeIII-OUTLET SEPTUM deficient
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HEMODYNAMIC
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Pan-systolic murmur (in small VSD)
During ventricular systole
Left and right ventricles shows a pressure gradient
Pansystolic murmur
Masking the first heart sound andcontinues throughout systole with same intensity
At end of systole, closure of aortic valve
Pressure in both ventricles reaches same level
No pressure gradient is present
Murmur ends at the second heart sound
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Ejection systolic murmur
(in muscular VSD)
shunt from left to right across the VSD
More blood in right ventricle
More blood flow across pulmonary valve
Ejection systolic murmur
- Ejection systolic murmur cant be separated from pansystolic murmur
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Delayed diastolic murmur
Large amount of blood in right ventricle
Passing through the lungs
Blood finally reach left atrium increases left atrial enlargement
Large amount of blood passing normal mitral valve
Delayed diastolic murmur at apex
- Intensity and duration related to size of shunt (Large VSDs)
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Small VSD Large VSD
Smaller than aortic valve (up to 3mm)Symptoms:- Asymptomatic
Same size/ bigger than aortic valveSymptoms:-Heart failure with breathlessness
and failure to thrive after 1 week old- recurrent chest infectionPhysical signs:-May have thrill at lower sternal edge-Loud pansystolic murmur at lower
left sternal edge-Quiet pulmonary second sound
Physical signs:-Active pericodium-Soft pansystolic murmur
-Apical delayed-diastolic murmur-Loud pulmonary heart sound-Tachypnoea-Tachycardia-Enlarged liver from heart failure
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Small VSD Large VSDChest x-ray-Normal Chest x ray- Cardiomegaly
- Enlarged pulmonary arteries- increased plmonary vascular
markings- pulmonary edema
ECG:-Normal ECG:- Biventricular bypertrophy by 2
months of age and signs ofpulmonary hypertensionEchocardiogram- Demonstrates the precise anatomyof the defect
Echocardiogram- Demonstrates the anatomy of thedefects, haemodynamic effects and
severity of pulmonary hypertension
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CAT SCAN(Computed Axial Tomography)
MRI
ULTRASOUND
ANGIOGRAPHY
(cardiac catheterization and angiography)
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Small VSD Large VSD
-Will close spontaneously- when it present,
- maintain good dental
hygiene- antibiotics prophylaxisbefore dental extraction or anyoperation to prevent endocarditis.
-Drug therapy for heart failure diuretics with captopril- additional calories input
-Surgery performed at 3 6months:- manage heart failure- manage failure to thrive- prevent permanent lung damage
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Congestive cardiac failure
Infective endocarditis
Aortic insufficiency
Complete heart block Delayed growth & development (FTT) in infancy
Damage to electrical conduction system during
surgery(causing arrythmias) Pulmonary hypertensionEisenmengers
syndrome
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3 MAJOR TYPES SMALL (less than 3mm
diameter)- hemodynamically
insignificant
- b/w 80-85% of all VSDs- all close spontaneously
* 50% by 2yrs* 90% by 6yrs
* 10% during school yrs- muscular close sooner
than membranous
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MODERATE VSDs
* 3-5mm diameter
* least common group of children(3-5%)
* w/o evidence of ccf/ pulm.htn can befollowed until spontaneous closure occurs.
LARGE VSDs
* 6-10mm in diameter* usually requires surgery otherwise
develop CCF & FTT by age of 3-6mths.
Conservative treatment
- treat CCF & prevent development ofpulm.vascular disease
- prevention & treatment of infectiveendocarditis
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Thank you