Ventricular Septal Defect. Deena Abdel_Hadi. Embryology. At the 2nd intra-uterine week , when the embryo is only 1.5 mm long the heart begins to take shape , a functional circulatory system has been established by the 4th week ; the ventricular septum is fully developed by the 8th week.
Cardiac lesion is usually found via a routine physical exam. (harsh ,loud ,blowing,left parasternal holosystolic murmer on left lower sternal border .
The systolic murmer maybe not audible via the 1st few days(limited left-to-right shunt d.t.higher right side pr.
CXR usually normal .
ECG usually normal but may suggest LVH
(RVH suggest pulmonary HTN , large VSD ,or associated symptom as pulmonary Stenosis)Clinical Manifestationssmall defects with trivial left-to-right shunts & NL. Pulm. Art. Pr.
A palpable parasternal lift , a holosystolic murmer , less harsh & more blowing d.t. absence of a significant pr. Gradient across the defect.
CXR showed increase broncho-vascular markings ,gross cardomegaly with prominence of both ventricles , left atrium & pulmonary artery, frank pulm. edema & pleural effusion.
ECG shows bi-ventricular hypertrophy , P wave maybe notched or peaked.Clinical Manifestationslarge defects with excessive pulmonary blood flow & pulmonary HTN