2. The ventricular septal defect is a communication
within the interventricular septum allowing shunting
of blood between the ventricles.
VSDs are the commonest isolated congenital heart
defect in children represent 20% of congenital heart
disease.
VSDs are frequently associated with more complex
cardiac malformations.
3. Classification:
Membranous (Gerbode defect).
Perimembranous.
Trabecular (Muscular).
Outlet: supracristal, infracristal
Also called infundibular or conal.
Inlet: Also called AV canal (AVC) type defects.
4.
5. Membranous (Gerbode defect).
The membranous septum is a very small area located
between the anterior and septal leaflets of the TV.
The defect is above the TV, which overlaps a small
segment of the RA.
Results in a LV-to-RA shunt.
6.
7.
8. Perimembranous VSDs
A defect in the IVS adjacent to the
membranous portion of the IVS and septal
leaflet of the TV.
Most common type of VSD represent 80% of
all VSDs.
9. Best imaged in:
Parasternal long axis view.
Parasternal short axis view at 10 o’clock.
Apical 5 chambers view.
10.
11.
12. VSDsMuscular
Second most common type of VSD.
Can be located anywhere in the muscular septum,
including: Anterior, posterior, mid, and apical.
Multiple muscular VSDs with a net moderate to
large shunt may be referred to as “Swiss cheese”
defects.
13. Best imaged in:
Parasternal long axis view.
Subcostal and parasternal short axis view for
anterior to posterior assessment.
Apical views for base-to-apex assessment.
14.
15.
16. Inlet VSDs
Located posterior and superior in the inlet
septum beneath the septal leaflet of the TV.
Associated with endocardial cushion defects
(also called AVC defects) including AVV
defects and primum ASDs.
20. Outlet VSDs
Located inferior and anterior to the
pulmonary valve.
Defects do not close spontaneously.
Least common defect, representing 6% of
VSDs.
25. 1: Evaluate the Ventricular Septal Defect
Location and Type:
The IVS is a three-dimensional (3D) structure
requires multiple imaging planes for evalution.
Use both two-dimensional (2D) and color Doppler
mapping to identify ventricular shunting lesions.
Scan the entire septum from the base to the apex
of the heart.
26. 2: Evaluate Ventricular Septal Defect
Size:
VSDs are classified as:
Small: less than one third LVOT diameter.
Moderate: one third to two thirds LVOT
diameter.
Large: greater than two thirds LVOT diameter.
27. Measurements should be obtained on 2D
images as measurements obtained on
images with color Doppler overestimate
size.
28. 3: Evaluate the Direction of the Shunt:
Shunting primarily occurs in systole.
The shunt is left to right in smaller lesions with
normal pulmonary resistance.
Both color Doppler and spectral Doppler
evaluation are useful when evaluating shunt
direction.
29. 4: Evaluate the Effects of Shunting:
Volume overload is reflected by:
Left atrial dilation.
Left ventricular enlargement and
hypertrophy.
30. Pulmonary hypertension may be present reflecting
changes from chronic volume overload.
Estimate PA pressure (in the absence of pulmV
disease) using a tricuspid regurgitation (TR) jet.
Take care to avoid contamination of the TR jet
from the VSD jet.
31.
32.
33.
34.
35. Transcatheter closure can be considered in
patients with:
Increased risk factors for surgery.
Multiple previous cardiac surgical interventions.
VSDs that are poorly accessible for surgical closure.
In muscular VSDs that are located centrally in the
interventricular septum.
36. Transcatheter closure is not suitable in:
Supracrystal VSD.
Malalignement VSD.
Associated significant aortic regurgitation.
Prolapse of aortic cusp.
Sub-aortic stenosis.
Sub-pulmonary stenosis.
37.
38. 3D echocardiography permits projection of
an en face view of the VSD from which
accurate sizing can be performed
irrespective of the shape or location of the
defect.
39. VSDs may often have unusual or irregular
shapes and the 3D technique has the ability
to display such morphology and assist in the
selection of the appropriate occlusion device
40. Assessment of adjacent structures and “rims”
of the VSD is a major strength of 3D
echocardiography compared to 2D
echocardiography, because all rims around
the defect can be visualized in a single
sonographic projection and viewed from
either the left or right ventricle.
41. With the use of live 3D echocardiography,
the precise orientation of the occlusion
device and guidance of catheters can be
accurately monitored.