Download Echocardiography Evaluation of Ventricular Septal Defect

Echocardiography Evaluation of
Ventricular Septal Defect in
Children and Adults
Herbert G. Whitley, MD
Pediatric Cardiology
I have no disclosures
Objectives
• Describe and understand the different
types of VSD’s
• Recognize the importance of the location
of VSD’s to the long term outcome and
followup
• Describe the acquired lesions associated
with perimembranous VSD’s
VSD
• Most common heart defect
• Account for 30% or more of isolated heart
defects, and present in 50% of all defects
• Not common in adults, about 10% of CHD
• Frequent spontaneous closure of small
and even medium sized defects
• However, other abnormalities a/w VSD’s
which may persist
Ventricular Septal Defect
Types of VSD’s
• Perimembranous (80%)
• Outlet (or supracristal) (5% in North
America, 30% in Japan)
• Inlet (or AV canal type) (5-10%)
• Muscular (5-20%)
• Malaligned (anterior or posterior)
Location of VSD’s
Ventricular Septal Defect
Perimembranous VSD’s
• Most common significant defects
• Frequently close spontaneously, but many
definitely persist into adulthood
• Close by apposition of TV septal leaflet
over the defect (VSD aneurysm)
• Associated lesions
– Double chambered RV (5-10%)
– Subaortic membrane (< 5%)
– Aortic regurgitation ( 5-10%)
Closing VSD
Double chambered right ventricle
Outlet (or supracristal) VSD
• Do not close spontaneously
• Virtually all will need repair, even small defects
• Aortic regurgitation, most commonly develops
between 5-10 years of age, and is progressive.
• Develops in 50-87% of patients over time
• Prolapse of NC and/or RCC into defect
• AR may persist after VSD closure
• Sometimes valve repair or even valve
replacement is needed.
Muscular defects
• Nearly always small
• 80-90% of small ones close by one year of
age
• Can be a/w multiple defects (swiss cheese
septum)
• Apical ones can be hard to locate
• Almost impossible to close surgically, if
needed, usually done by catheter device
Inlet VSD
• Usually occurring with AV septal defects
• More common in Downs syndrome and
other chromosomal anomalies
• Have associated AV valve abnormalities,
preop and post op
• Rarely close or get smaller
• Nearly always need repair
Malalingnment defects
• Nearly always a/w with more complex
defects, and not isolated VSD’s
• Do not close spontaneously
• Anterior malalingment (TOF, DORV,
truncus arteriosus)
• Posterior malalingment (subaortic
stenosis, arch abnormalities)
Echo Evaluation of VSD
• Location
• Size
• Hemodynamic significance (left heart
enlargement, valve regurgitation,
ventricular function)
• Pulmonary pressures (by VSD or TR jet)
• Associated lesions
VSD’s persisting into adulthood
• Usually perimembranous and small
• Eisenmenger’s complex now rare
• Endocarditis most serious complication. Closure
of VSD reduces endocarditis risk by 50%.
• May develop left heart dilation, aortic
regurgitation, or PHTN as patients age
• Need to be aware of double chambered RV,
subaortic stenosis. Rarely these can develop
even after VSD closed.
• Ventricular or atrial arrhythmias more common
in adulthood
Summary
• Location of VSD very important in followup
and long term outcome
• Most common congenital heart defect
• Can develop acquired lesions, which must
be understood and looked for
• Many VSD’s close spontaneously
• A certain number do persist into adulthood
Types of VSD
Muscular
Perimembranous (under
TV septal leaflet + AV
Outlet-supracristal
(under PV + AV)
Inlet (under TV + MV)
Important for followup
and associated
defects
AV Canal