Ventricular septal defect differential diagnosis

• Shortness of breath
• Tachypnea
• Palpitation
• Paleness
• Failure to gain weight
• Sweating while feeding
• Frequent respiratory infections
• Fainting
• Chest pain
• Cyanosis

• Down syndrome
• ventricular septal defects in association with other malformation syndromes:
• fetal alcohol syndrome
• trisomy syndromes
• fetal hydantoin syndrome
• postrubella infection (German measles)
• maternal phenylketonuria (PKU)
• Tetralogy of Fallot
• Holt-Oram Syndrome
• FG Syndrome
• Genitopalatocardiac Syndrome
• Fryns Syndrome
• certain forms of Dandy-Walker Syndrome
• Cardiomyopathy-Hypogonadism-Collagenoma Syndrome
• Familial Idiopathic Cardiomyopathy
• Simpson Dysmorphia Syndrome
• Fetal Alcohol Syndrome
• DiGeorge Syndrome
• various Trisomy Syndromes
• maternal alcoholism
• maternal ingestion of phenylhydantoin
• postrubella infection
• maternal Phenylketonuria

• Echocardiogram

• Electrocardiogram (ECG)

• Chest X-ray

• Cardiac catheterization

• Pulse oximetry

• Small VSD: Observe, symptomatic treatment until spontaneous closure.
• Surgical repair:
• During first year of life
• Immediately if severe symptoms present
• Small VSD to prevent complications related to their locations, such as heart valves damage
• Nutritional support or tubal feeding if VSD causing tiredness of the infant during feeding
• Surgical repair
• Catheter procedure
• Hybrid procedure (surgical and catheter-based techniques)

• Small VSD usually closes spontaneously by 18 months. Up to 75% are closed by the age of 10.
• Medium to large VSDs often become smaller but remain patent and allow shunting of blood and eventual development of Eisenmenger’s syndrome and heart failure.
• If large defects are not corrected before pulmonary hypertension develops the prognosis is poor.
• Patients with the Eisenmenger’s syndrome have an average life expectancy of 33 years.
• Surgical correction provide a better outcome.

• Cyanosis mild or absent
• Congestive cardiac failure
• Right ventricular impulse
• Increased pulmonic component second heart sound
• Variable ejection systolic murmur, apical mid‐diastolic murmur (in large left to right shunt), pansystolic murmur (with atrioventricular valve regurgitation)

• Subaortic stenosis
• Ventricular hypoplasia
• Tetralogy of Fallot
• Atrial isomerism

• Antenatal ultrasound anomaly scanning (four‐chamber view)
• Postnatal diagnosis:
• ECG
• Chest radiograph
• Echocardiogram
• Magnetic resonance imaging
• Angiography

CHF:

• diuretics and vasodilator such as captopril

• digoxin (controversial)

feeding difficulties and failure to thrive

• nasogastric tube to

• Asymptomatic
• Soft, systolic ejection murmur over the pulmonic area (second intercostal space) combined with a wide, fixed splitting of S2
• Large defects:
• Exercise intolerance
• Cardiac dysrhythmias
• Palpitations
• Increased incidence of pneumonia, pulmonary hypertension and increased mortality

• Down syndrome
• Noonan syndrome
• Ellis van-Creveld syndrome
• Opitz syndrome
• Costello syndrome,
• Chondroectodermal dysplasia
• Rubella
• Holt-Oram syndrome
• Hurler syndrome

• Echocardiogram
• Chest X-ray
• Electrocardiogram
• Cardiac catheterization
• MRI
• CT scan

• Medical monitoring
• echocardiograms and annual exam to check for complications, such as pulmonary hypertension, arrhythmias, heart failure or valve problems
• Medications
• Surgery
• Follow-up care

• The surgical mortality rate increases with increasing age and pulmonary artery pressures.
• Patients < 45 years without heart failure and with systolic pulmonary artery pressures less than 60 mm Hg have a mortality rate of surgical repair < 1%

• Atypical continuous murmur which can be heard at the higher left sternal edge.
• May be associated with a wide pulse pressure due to the runoff to the pulmonary circulation.

• Preterm birth
• Congenital rubella syndrome
• Chromosomal abnormalities ( Down syndrome)
• Genetic conditions such as Loeys–Dietz syndrome
• Wiedemann–Steiner syndrome
• CHARGE syndrome

• Chest Radiograph
• Electrocardiogram
• Echocardiogram
• Magnetic Resonance Imaging and Computed Tomography
• Cardiac Catheterization

• Transcatheter Closure
• Surgical Therapy

• Prognosis depends on the size and magnitude of the shunt and the status of the pulmonary vasculature
• Small PDA has normal prognosis
• Large PDA with significant left heart volume overload:
• Congestive Heart Failure
• Hypertensive Pulmonary Vascular Disease
• Endarteritis
• Aneurysm of Ductus Arteriosus
• recurrent laryngeal nerve paralysis

• Asymptomatic, he hypertrophied right ventricle can maintain adequate flow across the obstruction even in severe stenosis
• Dyspnea
• Chest pain
• Palpitation on effort
• Epigastric pain (exercise-induced right ventricular failure and hepatic congestion)
• Presyncope or syncope on efforts (When the right ventricle fails to maintain adequate cardiac output)
• Sudden death (severe stenosis even when asymptomatic)

• Other congenital heart defects, such as atrial septal defect (ASD), ventricular septal defect (VSD), and persistent ductus arteriosus.
• Combined valvular and infundibular PS can be part of tetralogy of Fallot (ToF).
• Noonan syndrome

• Chest radiography
• Echo-Doppler ultrasonographic studies
• Transesophageal echocardiography
• Electrocardiography
• Procedures
• Cardiac catheterization
• Angiocardiography

• Surgical resection of the fibromuscular when significant hemodynamic compromise. The optimal time of surgery should be before the development of RV failure.
• Percutaneous balloon valvuloplasty, it is only partially effective
• Transcoronary alcohol ablation technique

• If right ventricular failure develops, right atrial pressure will increase, and this may result in systemic cyanosis.
• If pulmonary stenosis is severe, congestive heart failure occurs, and systemic venous engorgement will be noted