•most common CHD(30%) •SYNONYMS * Roger’s disease * Interventricular septal defect Abnormal communication between two ventricle ( from left to right ) 90 %defects are located in the membranous part of ventricle . typeI-MEMBRANOUS SEPTUM typeII-MUSCULAR SEPTUM typeIII-OUTLET SEPTUM deficient . . HEMODYNAMIC . Pan-systolic murmur (in small VSD) During ventricular systole Left and right ventricles shows a pressure gradient Pansystolic murmur Masking the first heart sound and continues throughout systole with same intensity At end of systole. closure of aortic valve Pressure in both ventricles reaches same level No pressure gradient is present Murmur ends at the second heart sound . Ejection systolic murmur cant be separated from pansystolic murmur . Ejection systolic murmur (in muscular VSD) shunt from left to right across the VSD More blood in right ventricle More blood flow across pulmonary valve Ejection systolic murmur . Intensity and duration related to size of shunt (Large VSDs) . Delayed diastolic murmur Large amount of blood in right ventricle Passing through the lungs Blood finally reach left atrium increases left atrial enlargement Large amount of blood passing normal mitral valve Delayed diastolic murmur at apex . Asymptomatic and failure to thrive after 1 week old .Small VSD Large VSD Smaller than aortic valve (up to 3mm) Same size/ bigger than aortic valve Symptoms: Symptoms: -Heart failure with breathlessness .recurrent chest infection Physical signs: -May have thrill at lower sternal edge -Loud pansystolic murmur at lower left sternal edge -Quiet pulmonary second sound Physical signs: -Active pericodium -Soft pansystolic murmur -Apical delayed-diastolic murmur -Loud pulmonary heart sound -Tachypnoea -Tachycardia -Enlarged liver from heart failure . pulmonary edema ECG: .Cardiomegaly . haemodynamic effects and of the defect severity of pulmonary hypertension .Demonstrates the anatomy of the defects.increased plmonary vascular markings .Demonstrates the precise anatomy .Enlarged pulmonary arteries .Biventricular bypertrophy by 2 months of age and signs of pulmonary hypertension ECG: -Normal Echocardiogram Echocardiogram .Small VSD Chest x-ray -Normal Large VSD Chest x –ray . CAT SCAN (Computed Axial Tomography) • MRI • ULTRASOUND • ANGIOGRAPHY (cardiac catheterization and angiography) . additional calories input -Surgery performed at 3 – 6 months: .prevent permanent lung damage .manage failure to thrive . -Drug therapy for heart failure – diuretics with captopril .manage heart failure .when it present.Small VSD Large VSD -Will close spontaneously . .antibiotics prophylaxis before dental extraction or any operation to prevent endocarditis.maintain good dental hygiene . Congestive cardiac failure Infective endocarditis Aortic insufficiency Complete heart block Delayed growth & development (FTT) in infancy Damage to electrical conduction system during surgery(causing arrythmias) Pulmonary hypertension Eisenmenger’s syndrome . 3 MAJOR TYPES SMALL (less than 3mm diameter) .hemodynamically insignificant .muscular close sooner than membranous .b/w 80-85% of all VSDs .all close spontaneously * 50% by 2yrs * 90% by 6yrs * 10% during school yrs . prevention & treatment of infective endocarditis .treat CCF & prevent development of pulm. Conservative treatment .htn can be followed until spontaneous closure occurs. MODERATE VSDs * 3-5mm diameter * least common group of children(3-5%) * w/o evidence of ccf/ pulm. • LARGE VSDs * 6-10mm in diameter * usually requires surgery otherwise… develop CCF & FTT by age of 3-6mths.vascular disease . Thank you .