Ventricular septal defect is a congenital defect of the heart, that occurs as an abnormal opening in the wall that separates

the right and left ventricles. Ventricular septal defect may also be associated with other heart defects. Small defects can close on their own. Physiology: 1. Pressure is greater in the left ventricle and promotes the flow of oxygenated blood through the defect to the right ventricle 2. Increased blood volume is pumped into the lungs, which eventually may become congested with blood, and may result in increased pulmonary vascular resistance. 3. If the pulmonary resistance is great, right ventricular pressure may increase, causing a reversal of the shunt, with the un-oxygenated blood flowing from the right ventricle to the left, producing cyanosis. During ventricular contraction (systole): Some of the blood from the left ventricle leaks into the right ventricle, passes through the lungs and reenters the left ventricle via the pulmonary veins and left atrium. Two Effects: (1) The circuitous refluxing of blood causes volume overload on the left ventricle. (2) Because the left ventricle normally has a much higher systolic pressure (~120 mm Hg) than the right ventricle (~20 mm Hg), the leakage of blood into the right ventricle elevates right ventricular pressure and volume, causing pulmonary hypertension with its associated symptoms. Serious cases, the pulmonary arterial pressure can reach levels that equal the systemic pressure. This reverses the left to right shunt, so that blood then flows from the right ventricle into the left ventricle (causing cyanosis because blood is by-passing the lungs for oxygenation).

Mild: Child may experience a murmur, mild exercise intolerance, fatigue, dyspnea during exertion, and severe repeated respiratory infections. Large defect: Same symptoms but appear within the first month of life. *If child is asymptomatic, no treatment is required, unless CHF develops or the child risks pulmonary change /extreme shunting, surgical closure of the defect is indicated. Clinical Manifestations: 1, Characteristic sign is a loud, harsh, pan systolic murmur that is generally heard best at the lower sterna border. 2. Severe overloading of the right ventricle causes hypertrophy and obvious cardiac enlargement 3. With increased pulmonary vascular resistance, dyspnea and frequent respiratory infections are common. 4. Signs of cyanosis are possible, including assuming a squatting position and decreased venous return.

O2 Blood from Lungs Left Atrium Mitral valve: Left ventricle Aorta BODY All of the blood from the body is eventually collected into the two largest veins: the superior vena cava, which receives blood from the upper body, and the inferior vena cava, which receives blood from the lower body region. Both venae cavae empty the blood into the right atrium of the heart. Right Atrium Tricuspid Valve: Right Ventricle blood is pushed into the pulmonary artery that branches into two main parts: one going to the left lung, one to the right lung. The fresh, oxygen-rich blood returns to the left atrium of the heart through the pulmonary veins.