{"id":230,"date":"2018-02-06T16:54:49","date_gmt":"2018-02-06T16:54:49","guid":{"rendered":"https:\/\/wp.uthscsa.edu\/ct-surgery\/?page_id=230"},"modified":"2020-07-31T18:29:57","modified_gmt":"2020-07-31T18:29:57","slug":"ventricular-septal-defect-back-congenital-heart-defect-diagnoses","status":"publish","type":"page","link":"https:\/\/lsom.uthscsa.edu\/ct-surgery\/patient-care\/congenital-heart\/conditions-we-treat\/ventricular-septal-defect-back-congenital-heart-defect-diagnoses\/","title":{"rendered":"Ventricular Septal Defect"},"content":{"rendered":"<p>VSD is the most common congenital heart defect, comprising 20-25% of all lesions and occurring in association with other defects about 50% of the time.\u00a0 Classification is based upon the location of the defect in the interventricular septum.\u00a0 The most common type is the\u00a0<em>membranous<\/em>\u00a0defect, located in the membranous septum directly under the aortic valve, near the bundle of His.\u00a0\u00a0<em>Muscular<\/em>\u00a0defects are located in the muscular and apical portion of the ventricle and are the most common type of uncomplicated VSD (isolated VSD without associated lesions).\u00a0 Multiple muscular defects may be present, constituting a \u201cSwiss-cheese\u201d type of VSD.\u00a0\u00a0<em>Infundibular<\/em>\u00a0defects (also referred to as conal, subpulmonary, subarterial, and supracristal) are located just below the pulmonic valve. This type may cause aortic insufficiency.<\/p>\n<p>Patients with small defects may be asymptomatic and diagnosed only secondary to a loud murmur at the left lower sternal border (smaller VSD = usually louder murmur).\u00a0 The murmur is usually not audible just after birth as the pulmonary vascular resistance (PVR) is too high to allow for a significant left-to-right shunt.\u00a0 Patients with larger defects may present with heart failure. \u00a0CXR will show increased pulmonary vascularity and possible cardiomegaly.\u00a0 Echocardiography is used to define the defect(s) and cardiac catheterization is not routinely performed but can be used for device closure or to investigate pulmonary vascular resistance or response to vasodilators.<\/p>\n<p>The majority of small membranous and muscular VSDs will close spontaneously, and as such, asymptomatic patients may just be followed.\u00a0 However, infants with heart failure symptoms despite medical \/ pharmacologic therapy require VSD closure.\u00a0 Children older than one year of age with pulmonary artery pressures greater than one half that of systemic pressure require repair.\u00a0 All VSDs associated with aortic regurgitation should be repaired.\u00a0 In adults, VSDs should be repaired when symptoms are present or the Qp:Qs ratio is &gt; 1.5:1.\u00a0 Fixed pulmonary vascular hypertension precludes operative repair.<img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-233 aligncenter\" src=\"https:\/\/lsom.uthscsa.edu\/ct-surgery\/wp-content\/uploads\/sites\/32\/2018\/02\/ventricular-septal-defect-.jpg\" alt=\"\" width=\"401\" height=\"349\" srcset=\"https:\/\/lsom.uthscsa.edu\/ct-surgery\/wp-content\/uploads\/sites\/32\/2018\/02\/ventricular-septal-defect-.jpg 401w, https:\/\/lsom.uthscsa.edu\/ct-surgery\/wp-content\/uploads\/sites\/32\/2018\/02\/ventricular-septal-defect--300x261.jpg 300w\" sizes=\"auto, (max-width: 401px) 100vw, 401px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>VSD is the most common congenital heart defect, comprising 20-25% of all lesions and occurring in association with other defects about 50% of the time.\u00a0 Classification is based upon the location of the defect in the interventricular septum.\u00a0 The most common type is the\u00a0membranous\u00a0defect, located in the membranous septum directly under the aortic valve, near [&hellip;]<\/p>\n","protected":false},"author":161,"featured_media":0,"parent":1337,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-230","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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