Ventricular Septal Defect (VSD)

00:01 This is absolutely the most common congenital heart defect, and that's a point of emphasis right there.

00:08 The most common congenital heart defect is the VSD.

00:12 This is simply a hole connecting the left and right ventricles.

00:18 There are many different types of VSDs and it depends on where in the septum this little hole is.

00:24 We have membranous VSDs that's about 75 percent of cases, that's just right through the membrane.

00:31 Muscular VSDs.

00:32 You may have a common AV Canal - we'll talk about that as a special case in a little bit.

00:38 Or you may have a septum in the outlet between the aorta and the pulmonary artery.

00:45 Generally, because the left side is higher pressures supplying those very high pressures to the body, the mixing lesions is going left to right.

00:55 In patients with a VSD, often you'll hear a murmur.

00:59 There's a couple of tricks to this murmur that you might not think of.

01:04 Remember, the pitch of a murmur have to do with the size of the hole it goes through.

01:10 Just like an organ, a very large pipe makes a low note.

01:13 A very large VSD makes a lower pitched murmur than a very small VSD.

01:19 They tend to be very loud when they're smaller because it's a very turbulent jet of blood cruising right through from the left to the right.

01:28 These small VSDs will be high-pitched, very loud murmurs.

01:33 This will eventually lead to congestive heart failure.

01:39 The larger the lesion, the more likely you're going to end up in congestive heart failure.

01:44 Those large lesions may have almost no murmur at all if it's the entire ventricle and it would be very low-pitched.

01:51 Those can be sometimes tricky to hear.

01:54 If these are left untreated, they can eventually lead to Eisenmenger's.

01:59 Here on your slide, you can see a picture of a child with typical clubbing of the fingernails.

02:05 This child has pulmonary disease from continuous overcirculation of their blood into the right side through their VSD.

02:14 Eisenmenger's is when that right side is now higher pressure than the left - blood is now going right to left.

02:21 This sort of patient would require a heart transplant and maybe even a heart-lung transplant if the lungs are bad enough.

02:29 A VSD is repaired fortunately in most cases by itself.

02:35 Many of these muscular and small defects will close on their own.

02:38 So, if it's a very small defect, it's likely not causing too much trouble for the child, keep an eye on that child.

02:44 Symptomatic patients will be treated with medications.

02:48 Probably the most common medication we see used is Lasix or furosemide.

02:54 Furosemide allows those lungs to diurese a little bit and have a little bit less wetness which allows the breathing to be a little bit easier.

03:04 Surgical repair is required in some of these children with very severe VSDs.

03:09 Usually happens in the first year of life, they place a patch or sometimes, they'll have to do an open repair.

03:16 That can be critical to ending this mixing which is really the primary problem.

03:22 Let's look at the worst VSD that you can imagine and that is both the VSD and an ASD and we call this the common A-V canal or endocardial cushion defect.

03:35 These patients are symptomatic very early.

03:39 If you imagine, the heart is really just one big turbulent chamber of blood with mixing, These patients will often be cyanotic.

03:48 Surgical correction is obviously needed.

03:51 We need to rebuild these various septums, so that this child is capable of keeping the two sides of his heart apart.

03:58 And what is a high yield fact on this one is that the most common defect in patients with Down syndrome is the common A-V canal Remember, the most common defect overall in congenital heart disease is the VSD, but the most common defect in patients with Down syndrome is the common A-V canal.