VSD cardiac surgery congenital heart disease

1. Ventricular Septal Defect
T. Ruangpratyakul, MD

2. Ventricular septal defect
• Hole between right and left ventricle
• most common non-cyanosis anomaly (20%)
• 0.5 : 1000 of live births
• 50% with complex congenital heart disease
• 5% relate to chromosomal syndrome

3. Anatomy

4. Classification
80%
8%
6%
10%

5. Commonly Associated Defects
• PDA (25%)
• Coarctation of aorta (10%)
• LVOT obstruction (4%)
• Congenital mitral valve stenosis (2%)
• Other: ASD, RVOTO, vascular ring, persistent Lt. SVC

6. Pathophysiology
PVR
Pulmonary
Hypertension
Eisenmenger’s

7. Natural History
• membranous, muscular type: spontaneous closure
• inlet type unlikely spontaneous closure

8. Indication for Surgery
• severe symptom (CHF, FTT)
• age> 1 year with Qp/Qs > 1.5
• children with PHT with reveresible with NO
• Asymptomatic with small VSD: follow up echo

9. Clinical feature
• tachypnea
• growth failure
• profuse sweating during feeding
• bulging precordium
• pansystolic murmur
• enlarged liver
• thready pulse

10. Diagnosis and Workup
Large VSD increase pul. blood flow
large central and peripheral PA,
enlarge LA, LV
Small VSD small Lt. to Rt. Shunt
CXR normal

11. • Echocardiography *Gold Stadard*
• Cardiac catheterization: only need to measure PVR, PAP

12. Surgical Technique

13. Membranous type

15. Inlet type

16. Outlet
type

17. Postoperative care
• no special treatment
• generally extubation within 24 hr
• AV block can last up 10-14 day
• Pulmonary hypertensive crisis: sedation, muscle
paralysis, hyperventilation, inhaled NO 5-40 ppm
Precipatate: tracheal suction,
acidosis, hypoxemia, high-dose

18. Result of Surgical treatment
• mortality 0% isolate VSD
• complex neonatal cardiac surgery, very low-weight
with isolate VSD mortality <5%
• repair in 1-2 yrs of life: normal growth, no late death
• severe pulmonary hypertension postop increase in 3-10yr
• higher mortality: sx age>5 yr, PVR > 7 U/m2, transient or
permanent complex heart block
Early Results
Late Results