VENTRICULAR SEPTAL DEFECT

Ms Afrin
Department of cardiac care technology
 INTERVENTRICULAR
SEPTUM
Interventricular septum is the thick wall,which separates the right and
left ventricles
Its position is indicated by anterior and posterior interventricular groove
BLOOD SUPPLY:

1/3 of septum – posterior interventricular of right coronary artery

2/3 of septum – anterior descending artery of left coronary artery
 VENTRICULAR SEPTAL
EFECT
VSD is a congenital acyanotic heart disease in the interventricular septum

that allow shunting of blood between the right and left ventricle
due to abnormal opening in the wall of the septum.

Left to right shunt

 TYPES OF VSD
Membranous ventricular septal defect(infracristal,perimembranous)
Atrioventricular septal defect(inlet,cushion type)
Muscular septal defect(trabecular)
Conal septal defect (outlet,infundibular,subpulmonary,supracristal)
MEMBRANOUS VENTRICULAR
SEPTAL DEFECT
Membranous VSDs are located in the left ventricle outflow tract beneath
the aortic valve.
When the tissue forms on the right ventricular septal surface, it is
termed as an aneurysm of the membranous septum
MEMBRANOUS VENTRICULA
SEPTAL DEFECT
ATRIOVENTRICULAR
SEPTAL DEFECT
AVSD is characterized by deficiency in the atrioventricular septum
It is caused by an abnormal fusion of the superior and inferior endocardial
cushion with the mid portion of the atrial septum and the muscular portion of
the ventricular septum
ATRIOVENTRICULAR
SEPTAL DEFECT
 MUSCULAR SEPTAL
EFECT
 Muscular VSDs are divided into separate distinct regional groups
 They are midmuscular, apical, anterior, and posterior
 Defects mostly occur in central or margin of the interventricular
septum
 MUSCULAR SEPTAL
DEFECT
CONAL SEPTAL
CT The location of the supracristal VSD is close proximity to
the aortic valve , accounts for the common development of
aortic insufficiency
Left to right shunting of blood through the defect will pull
aortic valve tissue
HYSIOLOGY
VSD is larger in the size at birth, it tend to become smaller
or closer in early childhood
If the closure is insufficient to prevent a large shunt,
pulmonary vessels may get damaged by ejectile force and
pressure of left ventricle
It will lead to irreversible pulmonary hypertension
PATHOPHYSIOLOGY
(EISENMENGERS SYNDROME)
CYANOTIC VENTRICULAR
SEPTAL DEFECT
 In some cases cyanotic ventricular septal defect will occur, in which
right to left shunting will takes place
 The main cause of this cyanotic vsd is pulmonary stenosis, where the
blood cannot flow free into the pulmonary artery so it cause the blood
to flow from right ventricle to left ventricle.
 CLASSIFICATION
The effect of VSD depends upon its size and blood flow imposed
by pulmonary arterial vessels

SMALL DEFECT(<0.5 cm often closes spontaneously)

LARGE DEFECT (>1.0cm 90 percentage need surgery)

 LARGE
DEFECT
SMALL DEFECT
 INVESTIGATIONS
 History and physical examination
 CHEST X RAY – RA,RV DILATATION, CARDIOMEGALY
 ECG- Right bundle branch block, right axis deviation

and right ventricular (RV) hypertrophy and strain.

 Echo – To assess ventricular defect size ,shunt ratio, type of vsd
 Computed tomography - CTA with ECG-gating allows direct

visualization of the defect. Large VSD’s may be seen on non-gated studies.

 MRI-May also show added functional information

(e.g. Quantification/shunt severity) in addition to anatomy.

Some muscular defects can give a “Swiss cheese” appearance owing to their
complexity.
SYMPTOMS
Small defect, there is no symptoms,but there is loud tearing murmur

at the left side of the lower sternum

Large defect is the main cause for the cardiac failure at ventricular level

Fatigue Cyanosis
Sweating Anorexia
Rapid breathing Poor weight gain
These symptoms indicate that the VSD will most likely not close by itself,
and therefore, require early treatment (VSD treatment).

If left untreated, Ventricular Septal Defect may lead to further complications

such as pulmonary hypertension, endocarditis, or Eisenmenger complex like situation.
 MEDICAL
NAGEMENT
DIGOXIN(lanoxin)

Increase the strenght of the heart contraction

FUROSEMIDE(lasin)

Decrease the amount of fluid in circulation and in the lungs

 BISOPROLOL(concor)

keep the heart beat regular

 SURGICAL
AGEMENT
CATHETER PROCEDURE

Insertion of catherter into a blood vessel of the femoral

vein, to the heart.
Then a specially sized mesh device called amplatzer is
used to close the hole
 OPEN HEART SURGERY
Surgery is used in VSD, when VSD is along with ASD, PDA, Tof,

TAPVC and TGA