VENTRICULAR SEPTAL DEFECT

Presentation By
Saidah Mafisah

Supervisor
Dr. Dr. Khalid Saleh, Sp.PD-KKV, FINASIM
 NAME : Ms. K
 AGE : 21 years old
 ADDRESS : Andi Caco Pangkep
 MEDICAL RECORD NUM :479121

 DATE OF ADMISSION : November 12th, 2015

 Chief Complaint : Shortness of breath
 Present Illness History : She has been suffering from
shortness of breath on and off throughout his life but
the complaint was at its worse a few days before
admission to the hospital. Other complaint includes
fatigue, lack of appetite and heartburn acocompanied
by nausea. DOE (+) , PND (-), ortopneu (-),chest pain
(-). Fever (-) , vomiting ( - ),cough ( - ). Defecation
and urination is normal
 Past Illness History :
 Patients had to be hospitalized Unhas with VSD, the patient refused surgery
 History of heart disease since childhood

 Famly illness history :

 No family with history of heart disease
 General Status
 Moderate illness/ well nourished / Compos Mentis

 Vital Status
 Blood pressure : 100/70 mmHg

 Heart rate :80 x/m

 Respiratory rate : 20 x/m

 Temperature : 36,5 oC
HEAD AND NECK
• No anemic, no icteric
• No cyanosis
• JVP R+ 1cmH20

LUNG
• Inspection : Symmetry left=right
• Palpation : Mass (-), no tenderness
• Percussion : Sonor
• Auscultation : Vesicular
Rhonchi -/-, wheezing -/-
HEART
• Inspection : Ictus cordis visible linea axillaris anterior sinistra
• Palpation : Ictus cordis palpable linea axillaris anterior sinistra
• Percussion : normal heart size
• Upper border 2nd ICS sinistra
• Right border 4th ICS linea parasternalis dextra
• Left border 5th ICS linea axillaris anterior sinistra
• Auscultation : Heart sound I/II regular, murmur (+) sistolik gr 4/6
LLSB

ABDOMEN
• Inspection : flat, follows breath movement
• Auscultation : peristaltic (+), normal
• Palpation : liver and spleen not palpable
• Percussion : tympani, ascites (-)

EXTREMITIES
• No edema
 Heart rate : 87 bpm, reguler
 P wave : 0.08’
 PR interval : 0.16’
 Axis : normoaxis
 QRS complex
 Duration : 0.08’
 ST segment : Normal
 T wave : T-inverted di V1

 conclusion :
 Sinus rhythm , HR 87 bpm, normoaxis
 Prominent parahiler
 Cardiomegaly (cti 0.54 ) with
left to right shunt
 Result Normal Values

RBC 4.18.106/mm3 (4,5 - 6,5).106/mm3

HGB 13.0 g/dL 14 - 18 g/dL

WBC 6.2/mm3 (4 - 10).103/mm3

PLT 226.103/mm3 (150 - 500).103/mm3

GDS 161 mg/dl 140 mg/dL

Ureum 28 mg/dL 10 - 50 mg/dL

Kreatinin 0.67 mg/dL < 1,3 mg/dL

SGOT 14 U/L < 38 U/L

SGPT 3 U/L < 41 U/L

Natrium 141 mmol/L 136-145 mmol

Kalium 3.7 mmol/L 3.5-5.1 mmol

Klorida 110 mmol/L 97-111mmol

 Perimembrane VSD
(diameter 1.73cm) , MSA
positive
 Systolic & Dystolic
Function of left
ventricle is good, EF 65%
 Moderate Tricuspid
Regurgitation, moderate
pulmonary hypertension
 A women 21 years old came to the hospital with complaint of
shortness of breath.She has been suffering from shortness of breath
on and off throughout his life but the complaint was at its worse a
few days before admission to the hospital. Other complaint includes
fatigue, lack of appetite and heartburn acocompanied by nausea.
DOE (+) From physical examination of the heart it is found that his
ictus cordis visible linea axillaris anterior sinistra and is palpable
linea axillaris anterior sinistra. The heart sound includes systolic
murmur gr 4/6 at the LLSB.
 The additional diagnostic test shows radiology result prominent
parahiler and ardiomegaly (cti 0.54 ) with left to right shunt, the
echocardiography shows perimembrane VSD (diameter 1.73cm), MR
positive. Systolic & Dystolic Function of left ventricle is good, EF
65%, Moderate Tricuspid Regurgitation and Moderate pulmonary
hipertension
 Ventricular Septal Defect
 Dyspepsia
 O2 2-4 L/min ( via nasal canule )
 Ranitidin 50 mg/12 hours/intravena
 Domperidon tab/ 8 hours/ oral
 Captopril 12,5 mg/ 8 hours/ oral
 Digoxin 0,125 mg/ 24 hours / oral
 Evaluation of vital signs
 Angiography coroner
Definition • A ventricular septal
defect (VSD) is a
hole or a defect in
the septum that
divides the 2 lower
chambers of the
heart, resulting in
communication
between the
ventricular cavities.
Small VSD :
-defect smaller than 1/3 of anulus aorta

Moderate VSD :
- defect ½ of annulus aorta.

Large VSD :
-defect more equal to annulus aorta
 At present, a multifactorial etiology
based on an interaction between
hereditary predisposition and
environmental influences is
assumed to cause the defects.
Maternal Genetic risk
factors factors
A family history of a cardiac
Maternal diabetes
or noncardiac defect

Familial congenital heart

Alcohol consumption
defects
 Pansistolik murmur

Increase RV vol
LV pressure > Left to right
VSD (hipertrophy,dil
RV pressure shunt
atation)

Increase
RV pressure > Pulmonary Increase vessel
pulmonary
LV pressure hipertension resistance
blood flow
cyanosis

Right to left
shunt LV volume
(esenmenger overload
syndrome)
Small defects

• asymptomatic

Medium defects (uncommon)

• associated with protective valvular or subvalvular pulmonary

stenosis
• dyspnea

Large VSDs (infancy)

• heart failure surgery

• pulmonary stenosis
• pulmonary hypertension (the Eisenmenger syndrome).
• Cyanosis, dyspnea, and syncope .
• diastolic murmur of aortic regurgitation
 Eisenmenger
syndrome/VSD +
Small VSDs Moderate VSDs Large VSDs
severe pulmonary
vascular disease
• normal vital signs • thrill • signs of CHF • tachypnea only
• Physiologic • pansystolic harsh • tachycardia, with exercise and
splitting of S2 murmur lower tachypnea, and not at rest.
• harsh, LSB , lower pitch hepatomegaly, • mildly cyanotic
pansystolic compare to small • cardiomegaly at rest but
murmur VSD • pansystolic profound
LSB(well murmur (poorly cyanosis with
localized) localized) + exercise.
• Small defects  diastolic rumble.
high pitched or
squeaky noise
 Chest
radiography

Magnetic
Echocardiograph resonance
y imaging (MRI)
Additional
Examinatio
n

Cardiac
Electrocardiograph
catheterizati
y (ECG)
on
Observation & follow up
• Small VSDs

Medical management
• Medium sized vsd
• CHF- treat with diuretics, ACEI
• 2-3 months follow up
• RV & PAH pressures assessed
Surgical
• Large vsd
 DSV

Heart failure (+) Heart failure (-)

Anti failure
Aortic valve Infundibular PH Spontaneous Smaller
prolaps stenosis closure

Fail Success PVD(-) PVD(+) Cath

PAB Cath FR<1.5 FR>1.5

Cath

Evaluate Reactive Non-

in 6 mths reactive

Conservative
Surgical closure/Transcatheter closure
 Large VSD with pulmonary hypertension
 VSD with aortic regurgitation
 VSD with associated defects
 Failure of congestive cardiac failure to respond to
medications