ESC VSD

Question 1

Name the 4 types of VSD based on location.

Answer 1

1. Perimembraneous
2. Muscular/trabecular
3. Outlet(with or without mal-alignment of the outlet septum)/ supracristal/subarterial/subpulmonary/infundibular/conal/doubly committedjuxta-arterial
4. Inlet/AVcanal/AVSDtype

Question 2

Embrology

Question 3

Embroilogy

Question 4

Presentation

Answer 4

1. Small restrictive defects. The pulmonary vascular resistance is not significantly elevated and the left-to-right shunt is small (Qp:Qs <1.5:1).

Question 5

Diagnosis

Answer 5

Large nonrestrictive defects in cyanotic patients who have developed Eisenmenger syndrome, with pulmonary vascular resistance at systemic levels and shunt reversal (right-to-left).

Question 6

Diagnosis

Answer 6

Patients who have had their defects closed in childhood. These patients may have VSD patch leaks.See Section 3.3 for recommendations on who should perform surgeries, cardiac catheterization, and other procedures in these patients; Section 3.4 for recommendations on diagnostic evaluation; Section 4.4.6 for evaluation and management of severe PAH and Eisenmenger syndrome; Figure 2 for a diagnostic and treatment algorithm for ventricular level shunt; and Table 14 for routine testing and follow-up intervals.

Question 7

Diagnosis

Question 8

Diagnosis

Question 9

Diagnosis

Question 10

Recommendation accaha

Answer 10

1. Adults with a VSD and evidence of left ventricular volume overload and hemodynamically significant shunts (Qp:Qs ≥1.5:1) should undergo VSD closure, if PA systolic pressure is less than 50% systemic and pulmonary vascular resistance is less than one third systemic.S4.1.3-1

Answer 11

Surgical closure of perimembranous or supracristal VSD is reasonable in adults when there is worsening aortic regurgitation (AR) caused by VSD.S4.1.3-1,S4.1.3-2

Answer 12

3. Surgical closure of a VSD may be reasonable in adults with a history of IE caused by VSD if not otherwise contraindicated.S4.1.3-3

Answer 13

4. Closure of a VSD may be considered in the presence of a net left-to-right shunt (Qp:Qs ≥1.5:1) when PA systolic pressure is 50% or more than systemic and/or pulmonary vascular resistance is greater than one third systemic.S4.1.3-4–S4.1.3-6

Answer 14

5. VSD closure should not be performed in adults with severe PAH with PA systolic pressure greater than two thirds systemic, pulmonary vascular resistance greater than two thirds systemic and/or a net right-to-left shunt.S4.1.3-7–S4.1.3-9