12.29.2011
VSD
Posted on 1:01 AM by know about heart
 |
| ventricular septal defect |
Results from incomplete separation of ventricular. Most defects is congenital of perimembranous .
TYPES
1. Congenital:
a.Perimembranous or paramembrenous
b.Muscular
c.Supracristal
2.Aquired
a.Stub injury
b.After MI(myocardial infarction)
GRADING OF VSD
1. Small VSD-Area <0.5 cm2/m2
2. Moderate VSD-Area 0.5 to 1cm2/m2
3. Large VSD-Area >1cm2/m2
Clinical feature:
Symptoms:
(i) Small defects: Asymptomatic
(ii) Large defect but pulmonary vascular resistance is not high: (Large left to right shunt).
§Congestive heart failure.
§ Growth failure
§ Repeated lower respiratory infection
(iii) Defect is large & high pulmonary vascular resistant: (Eisenmenger syndrome)
§ Easy fatigue
§ Shortness of breath
§ Dyspnea on exertion
§ Syncope
§ Cyanosis
Signs:
1. Small defect:
§ Load pansystolic murmur (maladie de Roger)
2. Large defect but pulmonary vascular resistance is not high:
Apex beat thrusting is nature.
§ Left parasternal lift.
§ Pansystolic murmur in the left parasternal are 4th/5th intercostal space. 3. Large defeat (Pulmonary HTN)
§ Cyanosis
§ Clubbing
§ JVP-normal but is wave is
§ Epigastric pulsation
§ Left parasternal lift
§ Palpable p2 Thrill present in the left parasternal are 4th/5th intercostal space.
§Soft early diastolic murmur in the left parasternal 4th/5th intercostal space.
Investigation:
X-ray chest:
§VSD seen
§Dilation of heart chamber
§Cardiomegaly
§Lung field-plethoric.
ECG
§Normal
§LVF (left ventricular failure)
§Biventricular hypertrophy
§Evidence of RVH
Echocardiography-diagnostic
Cardiac catheterization.
Rx:
(i) Small defects:
§ No Rx.
§ Prophylactic antibiotic for infective endocarditis
§ Good dental hygiene
§ Adequate nutrition
(ii) Large defect but pulmonary vascular resistance is not high: (Large left to right shunt) Medical:
§ Rx of congestive heart failure by digoxin & diuretic medical:
§ Rx of respiratory infection
§Surgical: Surgical repair of defect
(iii) Detect is large of high pulmonary vascular resistance (Eisenmenger’s syndrome)
§ No surgical Rx
§ Rx of congestive heart failure by digoxin & diuretics
§ Venesection
§ Heart-lung transplantation
Complication:
1. Congestive heart failure,
2. Infective endocarditis,
3. Eisenmenger’s syndrome
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