What is a VSD (Ventricular Septal Defect)?

Ventricular septal defect (VSD) is one of the most common types of congenital heart disease in children. It can exist alone or can be combined with other cardiovascular malformations. About half of the patients with congenital congenital heart disease have ventricular septal defects.

Basic Information

Visiting department

cardiology

Common locations

Ventricular septum

Common symptoms

Shortness of breath, sweating, pale, "asthmatic" wheezing, etc.

Causes of pediatric ventricular septal defect

Defects can occur anywhere in the ventricular septum. According to the location of the defect, it can be divided into: Periventricular ventricular septal defect: most common, accounting for 60% to 70%. It is located in the ventricular septum and involves adjacent ventricular septum. According to the extension direction of the defect, it can be divided into perimenemium. Inflow tract type, peritrabecular trabecular part type, and periplasmic outflow tract type. Large defects can extend to two or more locations, which are called perfusion membrane fusion types. muscle type ventricular septal defect: 15% to 25%, the membrane is intact. According to the location, it can be further divided into muscle inflow tract type, muscle trabecula type and muscle outflow tract type. The latter is separated from the pulmonary valve by muscle. Double arterial type: also known as pulmonary artery subvalvular type, accounting for 3% to 6%, but the incidence rate in the eastern population can reach 29%. Its main feature is the aortic and pulmonary valve annulus at the upper edge of the defect. Poor or absent development of the conjunctival and conic ventricular septum can reduce left-to-right shunt during coronary valve prolapse, and it is easy to cause aortic valve reflux. In some permembranous defects, especially the permembranous flow into the canal ventricular septal defect, it can be seen that the fibrous tissue derived from the tricuspid valve adheres to the margin of the defect, forming a pseudoventricular septum, which makes the defect smaller or completely prevents shunting and achieves natural closure. Defects are mostly single or multiple. May be combined with atrial septal defect, open ductus or aortic constriction.

Clinical manifestations of pediatric ventricular septal defect

Depends on the size of the defect, pulmonary blood flow, and pressure. Small defects, small shunts, mostly without clinical symptoms. Symptoms of medium-sized defects appear in infancy. Large defects occur 1-2 months after birth with shortness of breath and excessive sweating. Breastfeeding is often interrupted by shortness of breath, weight gain is slow, and the complexion is pale. With chronic left ventricular dysfunction, there is often irritability at night with "asthma" -like wheezing. Young children often have respiratory infections and are susceptible to pneumonia. Older children may experience symptoms such as weight loss, shortness of breath, palpitations, and weakness. Sometimes the dilated pulmonary artery compresses the recurrent laryngeal nerve, causing hoarseness. In the late stage (more common in children or adolescents) or those with large defects and significant pulmonary artery cramps, right to left shunts may appear, showing cyanosis and gradually increasing. If the defect shrinks with age, the symptoms also decrease.

Pediatric ventricular septal defect examination

1.X-ray chest radiograph

In small defects, there was no change in heart shadow, or only slight left ventricular enlargement or pulmonary congestion. The heart defect of medium defect increased to different extent, and the left ventricle was the main one. In large defects, the heart shadow increases moderately or severely, and the left ventricle is the main or the left and right ventricles and the left atrium are enlarged. If the pulmonary artery segment is prominent, it indicates pulmonary hypertension. The aortic node is small. Congestion of the lung field, widening of hilar vasculature, and thickening of lung texture. If there is organic pulmonary arterial pressure, although the hilar vascular shadow is thickened, the outer band of the pulmonary field is clearer, the pulmonary vascular shadow is suddenly interrupted (hilar truncation), and the heart shadow is slightly smaller than before.

2. Echocardiography

Two-dimensional ultrasound can directly display the defect, which is helpful for the diagnosis of the size and location of the defect. Doppler ultrasound can detect the maximum turbulence by following the defect from the right ventricle to the defect and the left ventricle. Doppler color blood flow imaging can directly see the shunt location, direction and different shunt size, which is more sensitive to the diagnosis of muscle defects and multiple defects.

Diagnosis of pediatric ventricular septal defect

Diagnosis can be confirmed based on typical signs, X-rays, ECG, echocardiogram, and cardiac catheterization.

Pediatric ventricular septal defect treatment

Medical treatment

Mainly prevent and treat infective endocarditis, lung infections and heart failure. By giving digitalis and diuretics, limiting salt intake and / or reducing afterload, and actively managing respiratory infections, children's heart failure can be controlled and their normal growth and development can be guaranteed.

Percutaneous interventional occlusion: Interventional occlusion is preferred for simple VSD after 2 years of age.

2. Surgical treatment

Large-scale defects occur within 6 months of medically uncontrollable congestive heart failure, including repeated pneumonia and slow growth, and should be treated surgically; children 6 months to 2 years of age, although heart failure can be controlled, but pulmonary artery pressure continues to increase, More than 1/2 of the systemic arterial pressure, or the ratio of pulmonary circulation to systemic circulation after 2 years of age is greater than 2: 1, and should be repaired in time. Patients with advanced organic pulmonary hypertension who have bidirectional or right-to-left shunts are not suitable for surgery.