Paeds Vivas · cardiology
Ventricular septal defect — branching viva
Branching viva from the recognition of the VSD murmur through the anatomic and haemodynamic classification, the four-to-eight-week heart-failure physiology, the device-versus-surgery decision, and the Eisenmenger management with family and pregnancy counselling.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in clinic. The consultant asks you to talk through four children: a well six-week-old with a loud murmur found at the check, a three-month-old in overcirculation failure, a two-year-old with a perimembranous VSD and new aortic regurgitation, and a sixteen-year-old lost to follow-up who now has Eisenmenger physiology.
Station opening
Examiner: "Define the ventricular septal defect and explain why its clinical course is set by its size." [1]
Strong candidate (must-hit)
- Defines the VSD as a congenital communication between the ventricles producing a left-to-right shunt because the left ventricle pumps at higher pressure; explains that the clinical course is set by shunt size, which depends on the defect size and the pulmonary vascular resistance, running from a tiny defect that closes to a large defect that floods the lungs, causes heart failure, and over years risks Eisenmenger syndrome. [1]
Weak candidate
- "A VSD is a hole in the heart that some children are born with." [1]
References7ShowHide
- [1]Hoffman JI; Kaplan S The incidence of congenital heart disease. J Am Coll Cardiol, 2002.PMID 12084585
- [3]Du ZD; Roguin N; Wu XJ Spontaneous closure of muscular ventricular septal defect identified by echocardiography in neonates. Cardiol Young, 1998.PMID 9855105
- [4]Butera G; Carminati M; Chessa M; et al Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. J Am Coll Cardiol, 2007.PMID 17868812
- [6]Galiè N; Beghetti M; Gatzoulis MA; Granton J; et al Bosentan therapy in patients with Eisenmenger syndrome: a multicenter, double-blind, randomized, placebo-controlled study. Circulation, 2006.PMID 16801459
- [7]Gatzoulis MA; Beghetti M; Galiè N; Granton J; et al Longer-term bosentan therapy improves functional capacity in Eisenmenger syndrome: results of the BREATHE-5 open-label extension study. Int J Cardiol, 2008.PMID 17658633
- [8]Wilson WR; Gewitz M; Lockhart PB; Bolger AF; et al Prevention of Viridans Group Streptococcal Infective Endocarditis: AHA Scientific Statement. Circulation, 2021.PMID 33853363
- [9]Baumgartner H; De Backer J The ESC Clinical Practice Guidelines for the Management of Adult Congenital Heart Disease. Eur Heart J, 2020.PMID 33128054