definition

- definition of nonrestrictive VSD

definition of nonrestrictive VSD

- VSD with the same size

- VSD larger than the aortic valve annulus

history

- คนไข้มีอาการอะไรบ้าง

คนไข้มีอาการอะไรบ้าง

- small VSD

- moderate to large VSD

epidemiology

- โอกาสที่เกิด spontaneous closure เป็นอย่างไร

โอกาสที่เกิด spontaneous closure เป็นอย่างไร

- small VSD : 30-50% in muscular VSD > membranous VSD

- moderate VSD : 8%

classfication

- classification of VSD

- classification of VSD by STS

- classification of VSD by Van Praggh

- classification of VSD by Anderson

- classification of VSD by ISNPCHD

classification of VSD

- isolation

- combination

- other assoications

 

classification of VSD by STS

- type I

- type II

- type III

- type IV

 

classification of VSD by Van Praggh

- conal septal defect

- cono-ventricular defect

- atrioventricular canal type

- muscular ventricular septal defect

 

classification of VSD by Anderson

- doubly committed juxta-arterial

- perimembranous

- muscular

 

classification of VSD by ISNPCHD

investigation

- EKG

- imaging

 

imaging

- CXR

- echocardiography

- cardiac catheterization

 

echocardiography

- severity of VSD by echocardiography

severity of VSD by echocardiography

** anatomy definition

- small < 4 mm

- moderate 4-6 mm

- large > 6 mm

cardaic catherization

- indication cardiac catheterization

- severity of VSD by cardiac catherization

- PVR index and further management

indication cardiac catheterization

- large defects but left-to-right shunt

- 1st year of age with normal or mildly increased LV size who have a large anatomical VSD

 

severity of VSD by cardiac catherization

** size of intracardiac shunt

- small VSD (Qp:Qs < 1.5)

- moderate VSD (Qp:Qs 2.5-3)

- large VSD (Qp:Qs > 3)

 

PVR index and further management

- PVRI < 8 WU : sx

- PVRI > 12 WU : no sx

- PVRI 8-12 WU : vasoreactivity testing

treatment

- supportive Rx

- surgery

 

supportive Rx

- supportive Rx ให้การรักษาอะไรบ้าง

supportive Rx ให้การรักษาอะไรบ้าง

- heart failure treatment

- nutritional support

- pharmacologic treatment

- ATB prophylaxis

- respiratory immunization

 

heart failure treatment

** ให้รักษาตาม severity

- mild : furosemide 1 mg/kg/dose 2-4 times/day

- moderate : furosemide 2 mg/kg/dose 2-3 times/day, spironolactone 1 mg/kg/dose 2-4 times/day

 

indication ATB prophylaxis

- use of prosthetic material or device

- residual defect near prosthetic device in dental or respiratory procedure

surgery

- indication surgery

- contraindication surgery

- type of surgery

indication surgery

- VSD with CHF with PHT

- VSD Qp:Qs > 1.5:1

- aortic valve prolapse ...

- all doubly committed ...

- prior episode of IE

 

contraindication surgery

- PVR > 12 WU

- suprasystemic PAP

 

type of surgery

- transcatheter closure

- open surgery

transcatheter closure

- indication transcatheter closure

indication transcatheter closure

- remote apical muscular defect

- multiple muscular defect

- unable to undergo cardiopulmonary bypass

open surgery

- indicaiton open surgery

- surgical approach of open surgery

indication open surgery

** age of 1 year

- persistent symptom with maximal medication

- PAP < 50% (PVRI < 8 WU-m2) with persistent large left-to-right shunt with LV dilatation (Qp:Qs >2:1)

- moderate to severe CHF with persistent medication 1 yr

- subpulmonic and membranous ... with ...

- double-chambered right ventricle


** age of 6 month

- severe symptoms with risk pulmonary hypertension

- large nonrestrictive VSD

** age of 3 month

- severe heart failure (respiratory distress)

 

surgical approach of open surgery

- transatrial approach

- transaortic approach

- right ventriculotomy

- apical ventriculotomy

complication

- complication of disease

- complication of transcatheter closure

- complication of open surgery

complication of disease

- heart failure

- pulmonary hypertension

- aortic valve regurgitation

 

complication of transcatheter closure

- AV block

- valve injury

- ventricular arrhythmia

- bleeding

 

complication of open surgery

- right bundle branch block

- complete heart block

follow up

- f/u คนไข้อย่างไร

f/u คนไข้อย่างไร

- small VSD

- moderate to large VSD