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Case History :

A child of age 3 years was brought with dyspnea on exertion for the last 6 months and on examination found to have loud pulmonary 2nd heart sound with mid sternal short systolic murmur. ECG showed severe right ventricular hypertrophy. Chest x-ray showed mild cardiomegaly and prominent pulmonary arteries with peripheral pruning. 2Decho showed bi-directional shunt across large ventricular septal defect. Patient was taken for cardiac catheterization.

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Investigation Reports :

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Discussion :

On Catheterization the following pressure readings(in mmHg) were recorded:

  • PA: 100/60/80 (sys/dia/mean)
  • RV: 100/4 (sys/end-dia)
  • RA: 4 (mean)
  • Aorta: 110/60/84 (sys/dia/mean)
Oxymetry revealed the following saturation readings:
  • PA: 88%
  • RV: 88%
  • RA: 74%
  • SVC: 70%
  • IVC: 72%
  • Aorta: 99%
Interpretation of the data:
  • Please note the step up of 14% oxygen saturation, from RA to RV indicating R to L shunt.
  • Severe PAH; after giving Oxygen the PA pressure fell down to 80 mmHg.
  • Angiography showed a large single subaortic VSD.
In view of the above findings, the patient is deemed operable and has been subjected to VSD closure.

Ventricular Septal Defect

The size of the defect and the pulmonary vascular resistance govern the consequences of a VSD:

    Small defect
  • large resistance to flow
  • no elevation of right ventricular or pulmonary arterial pressures
  • the left-to-right shunt may be so small that only selective left ventricular angiography or two-dimensional imaging with Doppler color flow mapping can detect it.
    Moderate size
  • still permits a separation of right and left ventricular systolic pressures
  • the right ventricular systolic pressure generally being 80 percent or less of the left ventricular systolic pressure
  • a large left-to-right shunt may be present with resulting pulmonary hypertension and dilatation and left ventricular volume overload.
    Large defect, approximately equal to or greater than the aortic valve orifice
  • no resistance to flow
  • the systolic pressures in both ventricles, the aorta, and the pulmonary artery are essentially the same
  • the relative resistance of the two vascular beds directly governs the relative proportion of blood going to the two circulations.