TY  - CHAP
M1  - Book, Section
TI  - Ventricular Septal Defects
A1  - Morales, David L.S.
A1  - Scully, Brandi B.
A1  - Fraser, Charles D.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyVentricular  septal  defect  (VSD)  is  the  most  common  noncyanotic  cardiac  anomaly  (20  percent  of  all  malformations);  it  is  present  in  over  50  percent  of  children  with  complex  congenital  heart  disease.  VSDs  occur  in  0.5  of  1000  live  births,  and  5  percent  are  related  to  chromosomal  syndromes.MorphologyVSDs  vary  in  size,  number,  and  location  along  septum.  They  are  classified  as  (1)  perimembranous  (PM,  most  common),  (2)  inlet  type,  (3)  nonmuscular  outlet,  and  (4)  muscular.  The  conduction  system  and  aortic  valve  leaflets  are  in  anatomic  proximity  and  are  at  risk  during  repair.PathophysiologyDegree  and  direction  of  shunting  between  the  right  and  left  ventricles  depend  on  size  (restrictive  or  nonrestrictive)  and  balance  between  the  systemic  vascular  resistance  (SVR)  and  pulmonary  vascular  resistance  (PVR).  Aortic  regurgitation  can  ensue  as  a  consequence  of  leaflet  prolapse  through  the  defect.Clinical  featuresSmall,  restrictive  defects  are  often  asymptomatic.  Symptoms  of  overcirculation  are  present  in  unrestrictive  VSDs;  with  the  development  of  irreversible  pulmonary  vascular  changes  in  untreated  large  shunts,  fixed  pulmonary  hypertension  and  cyanosis  develop  (Eisenmenger  syndrome).DiagnosisEchocardiography  accurately  defines  the  anatomy  of  VSD  and  associated  lesions.  Cardiac  catheterization  is  rarely  required.TreatmentTiming  of  closure  is  indicated  by  the  degree  of  shunting  and  aortic  valve  involvement,  and  is  most  typically  performed  in  infancy.  Transatrial  or  transventricular  approaches  are  most  commonly  utilized,  with  minimal  morbidity  and  mortality.  Percutaneous  or  periventricular  device  closure  is  still  experimental,  while  a  staged  approach  (with  pulmonary  arterial  banding  and  delayed  complete  repair)  is  now  considered  only  in  selected  cases.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104595698
ER  -