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Pathology

A defect in the ventricular septum, small defects are smaller than the aortic valve 
and large defects larger than the aortic valve 

Aetiology

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Signs

A thrill may be felt at the left lower sternal edge
Pansystolic murmur at lower left sternal edge – Maladie De Roger present
S2 is quiet/normal in small defects and loud in large defects 

Symptoms

May be asymptomatic if small
Larger defects present early after 1 week of age with symptoms of heart failure or recurrent chest infections. 

Investigations

ECG: Varies from normal to the presence of right ventricular hypertrophy 
Chest X-Ray: Cardiomegaly and increased pulmonary vasculature 
Echo: Assesses heart structure and confirms defect

Treatment

Conservative Management: Asymptomatic small VSDs close spontaneously
Medical: Treat symptoms of heart failure 
Surgical: Correction required by 3-5 months of age for large defects 

Prognosis

Prognosis is good once defects corrected however if untreated then development of Eisenmenger Syndrome is a life threatening complication.
If surgical correction not performed, heart failure and pulmonary hypertension 
may occur in large defects 
Eisenmenger syndrome may develop if large defects not treated
Infective endocarditis
Aortic Regurgitation

Key Facts

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Key Images

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Key References

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