Hi, my name is Tom and in this episode we're going to be going through ventricular septal defects.

And you can find notes at zero to finals.com and in the zero to finals pediatrics book

and questions and flashcards to train your knowledge at members.0.0.0.com. So let's get straight

into it. A ventricular septal defect, or VSD, is a congenital hole in the septum or the wall

between the left and the right ventricles in the heart. The hole may be small with minimal effects or larger,

even affecting the entire septum. Ventricular septal defects may be associated with down syndrome

or Turner's syndrome. Let's go through the pathophysiology.

The pressure is higher in the left ventricle compared with the right ventricle.

Therefore, blood flows from the left ventricle to the right ventricle across the ventricular septal defect.

This means blood continues to flow to the lungs to get oxygenated so the patient does not

become cyanotic. However, this left to right shunt can cause right-sided overload, right-heart

failure, and pulmonary hypertension.

When the pulmonary pressure, meaning the pressure in the vessels in the lungs,

exceeds the systemic pressure, meaning the pressure in the vessels of the rest of the body,

then blood will start to flow from the right ventricle to the left ventricle, becoming a right to left shunt.

This means that deoxygenated blood bypasses the lungs and the patient becomes cyanotic.

The change to a right to left shunt with the development of cyanosis is called Eisenmenga syndrome.

Let's talk about the presentation.

Often ventricular septal defects are initially symptomless and patients can present as late as adulthood.

They may be detected during antenatal scans during pregnancy or on the newborn baby check. Typical symptoms if they are symptomatic include poor feeding, dysknear or

shortness of breath, tachyknea or a a raised respiratory rate, and failure to thrive.

Let's go through the examination findings.

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