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    Ventricular Septal Defect (VSD) – Pathology And Clinical Manifestation

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    Ventricular Septal Defect (VSD) is the commonest congenital heart conditions which may be an isolated VSD or as part of a complex heart condition which may be a complete endocardial cushion defect, tetralogy of fallot or truncus arteriosus. It is also referred to as 'hole in the heart'. The defect is seen in the septum that separates the right and left ventricles.

    It is a disease complex that affects both boys and girls and because of this defect there is a left to right shunting of blood ie movement of blood from the left part of the heart to the right part.

    PATHOLOGY

    This defect can occur any where along the septum and most commonly at the membranous part of the septum. It may also be seen at the muscular part and often not are usually multiple and tiny leading to what is referred as 'Swiss cheese appearance'. In the normal dynamic of blood flow in the heart, the pressure in the left side of the heart is higher than the right and thus blood initially flows from the left side of the heart to the right side which will lead to flooding of the lungs and a reduction in the cardiac output which is the amount of blood pumped from the heart into the systemic circulation.

    CLINICAL MANIFESTATION

    Depends on the size of the defect and the level of left to right shunting. In small sized VSD, these children are usually asymptomatic and such defect is detected during routine medical check up Medium and large VSD tend to present early in childhood where the child will get fatigue easily as seen in pausing while breast feeding, excessive sweating, poor weight gain, recurrent chest infection, early onset congestive heart failure. Signs may include tachycardia (fast heart beat), tachypnea (fast breathing), tender hepatomegaly (liver), precordium bulge in long standing heart failure, enlarged heart, a murmur which is an abnormal sound heard with the aid of the stethoscope is heard which is usually a systolic regurgitant murmur of grade ll to V heard best at the lower left sternal border. When pulmonary hypertension sets in, a loud P2 may be heard and a diastolic rumble is also heard at the apex of the heart when there is excessive left to right shunt.

    VSD is a treatable condition treated by both medical or surgical modalities. With the availability of sophisticated imaging tools like electrocardiography and MRI the type and location of the defect can be made with ease and treated thereafter. It is worth mentioning that smaller VSD then to close up spontaneously before the age of 4 and even larger ones tend to reduce in size.



    Source by Ekpeno S Inyang

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