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2. History
Roger
Eisenmenger
Lillehei, Varco
2. Etiology
Chromosomal
Familial
Geographic
Environmental
Morphology of VSD
1. Size
1) Large
: approximately the size of aortic orifice
2) Moderate : still restrictive, but sufficient size to raise
RV pressure to of LV and Qp/Os>2.0
3) Small
: insufficient size to raise RV pressure &
Qp/Qs < 1.75
2. Location
1) Perimembranous VSD :
80%
2) VSD in RV outlet
: 5-10%
3) Inlet septal VSD
:
5%
4) Muscular VSD
:
5%
5) Confluent VSD
6) VSD with straddling or overriding TV
Extension
Inlet
Anterior
Outlet
Muscular
Outlet (conal)
Trabecular
Inlet
Anterior
Apical
Doubly committed subarterial (RV outlet)
Inlet septal
Atrioventricular septal type
Malalignment
Anterior (TOF)
Posterior (COA, IAA)
Rotational (Taussig-Bing)
VSD MO type
VSD MO type
2. Clinical features
Symptoms and signs of heart failure
Cardiomegaly & large pulmonary blood flow
Pansystolic or systolic murmur
Biventricular or left ventricular hypertrophy
3. Two-dimensional echocardiography
4. Cardiac catheterization & angiocardiography
Spontaneous closure
Pulmonary vascular disease
Bacterial endocarditis ; rarely recently
Premature death
Clinical course
Development of aortic incompetence
Development of infundibular PS
2. Rate
About 80% of VSD at 1 month eventually narrow or close
About 60% of VSD at 3 months eventually narrow or close
About 50% of VSD at 6 months eventually narrow or close
About 25% of VSD at 12 months eventually narrow or close
Becomes rare after 12 ~ 18 months of age
Description
<4
4 ~
5 ~
8>
5
8
Normal
Mild elevated
Moderately elevated
Severely elevated
Techniques of Operation
1. Route
1) Right atrium
2) Right ventricle, or left ventricle
3) Pulmonary artery
2. Repair of VSD
1) Conoventricular VSD
2) Juxtaarterial VSD
3) Inlet VSD
4) Muscular VSD
VSD Operation
VSD AV
Canal type
(A) Trabeculations overlying the VSD are taken down. (B) Interrupted
pledgetted sutures are placed full thickness at the superior margin of the
defect, maintaining the pledgets on the left ventricular side (C) Closure of
the VSD with a Dacron patch
5. Physical development
6. Conduction disturbance
7. Cardiac function
8. Residual shunting
9. Pulmonary hyperinflation
10. Iatrogenic aortic or
tricuspid incompetence
11. Pulmonary hypertension