Ventricular Septal Defect 

Introduction 

-VSD is a hole between the LV and RV 

-Most common congenital heart defect

-There are four types, classified by location: membranous, muscular, inlet and outlet  

-Muscular are the most common type 

-Membranous VSD are the most common type requiring surgical intervention (80% of cases) 

-There is no gender predilection 

-VSD allows oxygen-rich blood from the left ventricle flow into the right ventricle, which is pumped back to the lungs, even though this blood does not need oxygen. This puts more stress on heart and lungs 

Symptoms & Signs 

Symptoms correlate with size 

-Poor weight gain, dizziness, feeling tired all the time, sweating, shortness of breath 

-Complications: cyanosis with pulmonary hypertension, Eisenmenger syndrome, endocarditis, heart failure 

Small shunts are associated with loud, harsh holosystolic murmurs in the left third and fourth interspaces along the sternum with a narrowly split second heart sound 

Diagnosis

Chest X-ray: cardiomegaly, enlarged PA, increased vascular markings 

ECG: normal or right, left, or biventricular hypertrophy 

Echocardiogram: confirms diagnosis 

Treatment 

-Degree of shunting measured during cardiac catheterization dictates management 

-Asymptomatic small shunts do not require treatment 

-Medium and large VSDs may need to be fixed with surgery or heart catheterization 


Coarctation of Aorta 

Introduction

Coarctation of the aorta is the narrowing of the aorta where the ductus arteriosus (ligamentum arteriosum after regression) inserts 

Preductal: identified in infancy; early presentation of symptoms 

Postductal: identified in early adulthood; later presentation of symptoms 

-Most common site of coarctation is distal to the left subclavian artery

-Poses high risk for aortic aneurysm, dissection, rupture, CHF, stroke 

-Associations: Turner’s syndrome, Berry aneurysms, Bicuspid aortic valve 

Symptoms &  Signs 

Infants: pale skin, difficulty feeding, difficulty breathing, irritability 

Adults: Exertional dyspnea, headache, epistaxis and leg fatigue, 

-Hypertension in the arms, with low or normal pressure in the legs 

-Absent or weak and delayed femoral pulsations in comparison with the brachial or radial pulse 

-A continuous murmur loudest at left infrascapular region, posterior inter scapular area, 

-Lower blood pressure in the legs than in the arm

-Cyanosis in lower half of the body 

Diagnosis 

Radiography 

Rib notching: scalloping of the inferior portion of the ribs due to enlarged intercostal arteries 

3 sign: aortic arch and dilated left subclavian artery forming the upper curvature and poststenotic dilation of the descending aorta forming the lower

ECG: left ventricular hypertrophy, left atrial enlargement 

Echocardiography, CT, MRI

Treatment 

balloon angioplasty, Endovascular stenting, or surgery