Imaging of Ventricular Septal Defects.ppt

Imaging characteristics of ventricular septal defects

1. Ventricular Septal Defects
Reporter: Rainier U. Mendoza

3. Ventricular Septal Defects
•most common congenital heart disease
(25%)
•Most common type: perimembranous
(90%)
•Small muscular defects are more likely to
close (80%) compared to membranous
type (35%)
•moderate or large VSDs rarely close
spontaneously

4. Ventricular Septal Defects
•Small defect (<5 mm): pressure restrictive
–right ventricular pressure is normal
•Large defect (>10 mm): pressure
nonrestrictive
–right and left ventricular pressures are
equalized
–direction and magnitude of shunt is direced by
ratio of pulmonary to systemic vascular
resistance

7. Hemodynamics
•excess blood flow to
the lungs leads to:
–active pulmonary
vascular engorgement
–increased return of
blood to the left side of
the heart

8. Hemodynamics
•Diastolic overloading
•enlargement of the left atrium and left ventricle

9. Hemodynamics
Large defects:
•decompression of
blood from left to right
ventricle
•enlargement of both
left and right
ventricles

10. General radiograph of VSD
•Left atrial enlargement
–displacement of the left main bronchus posteriorly

11. Double Density Sign

13. General radiograph of VSD
•small aorta
–blood is shunted
away from
systemic
circulation before
reaching the aorta

14. General radiograph of VSD
•Enlargement of the
pulmonary artery
–increased high-
pressure pulmonary
blood flow
–pulmonary
hypertension is a
frequent complication

15. 2D Echocardiography
•shows position and size of the VSD
•estimates shunt size by examining degree
of volume overload of the left atrium and
ventricle
•In cases of supracristal VSD, determines
presence of aortic valve insufficiency or
aortic leaflet prolapse

16. Apical 4-chamber view
Color Doppler Imaging
showing left-to-right shunt

17. Angiography
•best done on the left anterooblique view
•Path of catheter:
Right side of the heart
Foramen Ovale
Left Atrium
Left Ventricle

21. MRI
•also used to demonstrate VSDs
•has not replaced angiocardiography and
ultrasonography

23. Thank you!

24. Sources
•Swischuck, Imaging of the Newborn,
Infant, and Young Child, 5th Edition, 2004
•Nelson Textbook of Pediatrics, 20th
Edition, 2015