DR Medhat MRCP

Acyanotic congenital heart disease (left to right shunt)
1) Ventricular Septal Defects (VSD)
- It`s the most common congenital heart disease (around 50 % of cases).
- Non-congenital cause is post MI.
- The ventricular septum consists of an inferior muscular and superior membranous
(close to ANN) portion.
• Sites :
Perimembranous VSD (the most common `80%`)
Muscular VSD (15%) : subdivided into muscular inlet ,outelet & trabecular
• Features
Classically a pan-systolic murmur/ left parasternal area which is louder in smaller
defects
• Complications
1. Aortic regurgitation* ( due to right coronary cusp prolapce)
2. Infective endocarditis.
3. Eisenmenger's complex
4. Right heart failure.
• Management : According to Fick equation to calculate LT to RT shunt ratio.
- Where Qp = pulmonary flow , Qs = systemic flow ,A0 =Aortic saturation , MV =
mixed venous saturation , PV = pulmonary venous saturation
- When :
> 2 surgery in children.
> 1.5 surgery in adult .
69