V.S.D
Parts of Interv. Sept.


membranous part

muscular part
2 types
I- V.S.D in muscular part (Roger’s d.)

s It usually closer during systole
So, It is haemodynamically insignificant.

C/P No chamber ++ (mild defect)
murmur long systolic not pansystolic

ttts close spontaneously
s prophylaxis against endocarditis

II- Membranous V.S.D




P++ Pr
­

Plethora &
­­ bl. flow cyanosis to the Lt. side
(Esinminger’s )

Q -
Chamber ++


Lt. V. Lt. A Rt. V

V . load V. load. P
++ (pressure load)

C/P
Infection (chest)
Palpitations
¯ COP (severe V.S.D.)
Cyanosis (causes )

exertional Eisenmenger’s associated P.S.

F4 2nd - 3rd
(reversed shunt) decade
P
++Pr­
pr
¯
s No P++

s age 3-5 yrs.

O/E
murmur pansystolic -loud - harsh
3 , 4th Lt. parast. line.
functional M.S.
3rd H.S. (apex) - S2 wide splitting.

Investigations

* E.C.G - X-ray Lt.V and Lt. A, pulm plethora
* Echo

Catheter
Pr
­­ in Rt. V.
O2
­­ in Rt. V.
pass through anomaly
dye

Treatment
1- severe closure


2- mild follow up till spontaneous closure (usually
within age of 4 yrs)

if closed if not closed
ü follow up by echo
for p++

' pulm pr. ­'pulm pr, not high
social closure follow up
indicated
+ prophylaxis to avoid Eisenmenger’s against
syndrome endocarditis



Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)