Ventricular septal defect
VSDs account for 25% of all CHD (2/1000 live births). They may occur in isolation or as part of complex malformations. The clinical features depend on the size and location of the defect.
· Large/small VSD.
· Multiple/small defects (maladie de Roger).
· Asymptomatic (typical/early).
· Heart failure (breathlessness—after the first few days of life).
· Recurrent chest infections.
· Cyanosis (rare after 1st decade of life)—s to Eisenmenger syndrome.
· Endocarditis (late).
Pansystolic murmur—lower left sternal edge parasternal thrill.
The majority of defects will close spontaneously.
· Medical: treat heart failure if present.
· Surgery: indicated if severe heart failure; pulmonary hypertension. This is performed at 3mths of age, before the pulmonary hypertension causes pulmonary vascular disease (Eisenmenger syndrome).