VENTRICULAR SEPTAL DEFECT (VSD)

Congenital VSDs may close spontaneously during childhood. Symptoms relate to size of the defect and pulmonary vascular resistance.

History 

CHF may develop in infancy. Adults may be asymptomatic or develop fatigue and reduced exercise tolerance.

Physical Examination 

Systolic thrill and holosystolic murmur at lower left sternal border, loud P2, S3; diastolic flow murmur across mitral valve.



ECG 

Normal with small defects. Large shunts result in LA and LV enlargement.

CXR 

Enlargement of main pulmonary artery, LA, and LV, with increased pulmonary vascular markings.

Echocardiogram 

LA and LV enlargement; defect may be directly visualized. Color Doppler demonstrates flow across the defect.

Ventricular Septal Defect TREATMENT

Fatigue and mild dyspnea are treated with diuretics and afterload reduction (Chap. 133 ). Surgical closure is indicated if PF:SF >1.5:1 in absence of very high pulmonary vascular resistance.