Session 2 VENTRICULAR SEPTAL DEFECT .pptx

Knowledge on VSD

1. CMT06209: Apprenticeship in Paediatrics and Child Health Session 2 VENTRICULAR SEPTAL DEFECT (VSD ) Total Session time 120 minutes

2. Learning Objectives By the end of this session, a student is expected to learn the following; Explain aetiology/risk factors of Ventricular Septal Defect Outline epidemiology of Ventricular Septal Defect Explain clinical features of Ventricular Septal Defect Establish diagnosis/ provisional and differential diagnosis of Ventricular Septal Defect

3. Learning Objectives cont… Provide pre-referral treatment of Ventricular Septal Defect Provide appropriate supportive care for Ventricular Septal Defect Provide follow-up services of Ventricular Septal Defect

4. Ventricular Septal Defect (VSD) VSD – is an abnormal opening in the ventricular septum, which allows free communication between the right and left ventricles Most common of all CHD (30%-60%) 85% close spontaneously Follows incomplete development during early utero life

5. Types of Ventricular Septal Defect Four (4) Types: Perimembranous /membranous = commonest Infundibular ( subpulmonary or supracristal VSD) – involves the RV outflow tract Muscular VSD – can be single or multiple AVSD – inlet VSD, almost always involves AV valvular abnormalities

6. Pathophysiology of VSD During systole, the rise in left ventricular pressure (LVP) causes leaking of blood from LV to RV which will re-enters the LV from the pulmonary circulation Two net Effects: circuitous refluxing causes volume overload in LV leakage of blood to the RV increases the volume and pressure in RV causing pulmonary HT and it’s associated symptoms (including hypertrophy of the LA & LV)

7. Pathophysiology of VSD cont… Eisenmenger’s syndrome: Initially, there is Left to Right shunt of blood caused by high blood pressure in the left ventrical through (ventricular) septal defect Large defect causes increased pulmonary flow to the pulmonary vasculature Pulmonary hypertension (HT) develops Later, reversal of the shunt from left-to-right to right-to-left occurs Cyanosis and other symptoms of pulmonary HT sets in

8. Clinical Features of VSD Small - moderate VSD: (3-6mm) usually asymptomatic 50% will close spontaneously by age of 2yrs Large VSD: almost always have symptoms require surgical repair

9. Clinical Features of VSD cont… Symptoms develop between 1 – 6 months In infant with a large VSD sweaty and tachypnoiec (breathe faster) with feeds exercise intolerance (CHF) failure to thrive Recurrent respiratory infections

10. Clinical Features of VSD cont… Initially heart sounds are normal Tachycardia; gallop rhythm Pansystolic murmur, depending upon the size of the defect +/- palpable thrill (palpable turbulence of blood flow), hyperactive precordium Parasternal heave in larger VSD Displaced apex beat over time as the heart enlarges Later, cyanosis ensues as a result of shunt reversal

11. Investigations Chest x-ray - CXR cardiomegally , increased pulmonary markings ECG chamber hypertrophy (LV, bi-ventricular, or LAH) CXR&ECG are normal with small VSD ECHO defect location, size, RVP Other investigations are supportive such blood tests in recurrent chest infections

12. Ventricular Septal Defect Treatment Small VSD no surgical intervention; no physical restrictions reassurance and periodic follow-up endocarditis prophylaxis Symptomatic VSD initially medical treatment to be provided before referral include treatment of chest infections and anti-failure drugs such as afterload reducers & diuretics Refer for surgical closure

13. Supportive Care Mainly involves management of accompanying conditions such malnutrition with standard therapy counselling to parents and/or care-takers on the condition and what to be done

14. Key Points Ventricular Septal Defect (VSD) is an abnormal opening in the ventricular septum developing during early utero -life VSD is commonest of all CHDs Four types VSD exist, perimembranous /membranous, infundibular ( subpulmonary or supracristal VSD), muscular VSD and AVSD – inlet VSD

15. Key Points cont… Small - moderate VSD are usually asymptomatic and half of cases closes spontaneously by age of 2yrs Large VSD are almost always have symptomatic and requires medical and/or surgical repair

16. Evaluation What are features of Ventricular Septal Defect? What are the diagnostic investigations for Ventricular Septal Defect?