Ventricular Septal Defects - AHF.pdf

Ventricular Septal Definition Defects Ventricular Septal Defect (VSD) – failure of the interventricular septum to close properly...

Ventricular Septal Definition Defects Ventricular Septal Defect (VSD) – failure of the interventricular septum to close properly during fetal development leaving a defect that allows blood to shunt across the interventricular septum, usually between the Continued… Endocardial cushion Defect In some cases, the shunt is between the ventricle and the atria, known as an atrioventricular defect or endocardial cushion defect. This shunt involves a variety of anomalies related to the interatrial septum, interventricular septum, and the adjoining structures of the mitral valve and tricuspid valve. This type of VSD is common in children with Trisomy 21 (Down Syndrome).  Continued… Types: VSDs vary in diameter, from a pin hole to VSD types correlate to the components of the complete absence of the septum resulting in a ventricular septum. There is a wide variety of common ventricle. Many VSDs require surgical nomenclature available; these categories are repair; however, it is common for a small to based on the bordering anatomy. medium VSD to close spontaneously with the Nomenclature is a system of names or terms, or the rules for growth of a child. forming these terms in a particular field of arts or sciences. VSD Types Continued… Trabecular or muscular septal VSD (5-20%) – Inlet septal VSD (3-5%) located between the bodies of the left – bordered by the mitral ventricle and the right ventricle; usually low valve, tricuspid valve, on the septal wall, in the thicker, more and muscle; often muscular portion of the septum, close to the associated with an apex, completely surrounded by muscle. The atrioventricular septal patient may experience multiple defects giving defect it a Swiss cheese appearance (rare). Continued… Continued… Outlet septal VSD (aka supracristal VSD, 3-5%) Membranous septal or perimembranous septal VSD – located between the left ventricular outflow (80%, most common) – bordered by the tricuspid tract and right ventricular outflow tract, valve, aortic valve, and muscle; usually high bordered by the aortic valve, pulmonic valve, in the septal wall, in the thinner, more and muscle. This type of VSD has a strong flexible portion of the septum, closer to the association with aortic valve prolapse and valves and great vessels. Perimembranous VSDs aortic regurgitation. Prevalence is higher in are frequently aneurysmal, meaning they have a the Asian population. thin, stretchy portion of tissue extending into the right ventricle. IMAGE Continued… Malalignment septal VSD occurs when the two portions of the interventricular septum have failed to align properly during development; typically affects the anatomy of the other structures within the heart. Examples include Tetralogy of Fallot and Truncus Arteriosus – an abnormality where the aorta and pulmonary artery rise from the common trunk allowing the blood from both ventricles to mix together as it exits through a single valve from the heart. Image Continued… A large VSD places a burden on the heart due to the volume overload on both ventricles. The volume overload is due to a large amount of blood being ejected into the right ventricle and lungs (remember the shunt travels from left to right) however, this flow returns to the left ventricle so both ventricles experience an overload. Continued… History A VSD can cause an increase in pulmonary Asymptomatic (young patient and/or small shunt) vascular resistance resulting in pulmonary Heart failure (dyspnea, orthopnea, paroxysmal hypertension. Like the atrial septal defect, nocturnal dyspnea, fatigue, cough, weight gain) Eisenmenger syndrome can result in a right to left shunt, which leads to systemic cyanosis Infective Endocarditis Examination: Echo Aortic Insufficiency Utilize all views that visualize the interventricular septum. Mitral Regurgitation VSD usually presents as an echo free space along the Eisenmenger’s Syndrome (cyanosis, clubbing, interventricular septum tricuspid regurgitation, pulmonic Turbulent CFD travels through the VSD between the insufficiency) left ventricle and right ventricle Document the VSD location, size, velocity, and direction Calculate the Qp/Qs shunt ratio Evaluate associated findings (left ventricular volume overload, pulmonary hypertension, aortic valve prolapse, aortic insufficiency) Ratio - Formula Pulmonary Distress VSDs lead to pulmonary disease Left to right shunt Excess blood volume on right side Increased blood volume going to lungs Increased pressure in lungs Pressure backs up to the right heart Eisenmenger’s syndrome Poor oxygenated blood to systemic circulation Eisenmenger Syndrome Endocardial cushion defect Endocardial cushion defect (aka atrioventricular canal defect or atrioventricular septal defect) involves a combination of congenital heart anomalies that create a butterfly appearance. A hole in the center of the heart where the upper chambers meet the lower chambers allows oxygenated blood to mix with deoxygenated blood. A common valve in place of the mitral valve and tricuspid valve. Image Continued… Endocardial cushion defect is frequently associated with Trisomy 21 (Down Syndrome); however, in most cases the cause is unknown Endocardial cushion defects typically present in-utero, or anytime from birth to several months Continued… Note: The infant presents with: Partial endocardial cushion defects may Coughing Cyanosis not present until 20-30 years of age Dyspnea Fatigue Echo makes the diagnosis and surgery is Irregular or rapid heart rate necessary Murmur Poor appetite Poor weight gain Swelling Wheezing Pathology - Review Cleft Mitral Valve – is a slit-like hole or division of the mitral valve leaflets, most commonly the anterior mitral valve leaflet An isolated cleft posterior leaflet is extremely rare with very few documented cases. However, a 3D case was documented with multiple clefts, two in the posterior leaflet and one in the anterior leaflet. Evaluate the valve anatomy, and degree of the cleft edge fibrosis and retraction Regurgitation is common and should be addressed Surgical repair is typically required Associated cardiac lesions – Atrial Septal Defect (Primum)