The most common presentation of a VSD is that of a cardiac murmur. Babies with large VSDs can present with symptoms of heart failure such as rapid breathing and poor feeding.
The chest X-ray and electrocardiogram are often non-specific; they can be totally normal in small VSDs. In larger defects, the chest X-ray may show enlargement of the heart and increased blood vessel markings in the lungs.
The investigation of choice when a VSD is suspected is the echocardiogram. This will not only confirm the presence of the VSD (figure 3.4), it will also allow the cardiologist to assess the number and sizes of the VSD(s), as well as it's haemodynamic effects on the heart. The echocardiogram can also demonstrate the presence of any associated cardiac lesions.
Figure 3.4 Echo picture showing the presence of a VSD in the ventricular septum between the right and left ventricles.
In some cases of VSD where complications had raised (e.g. severe pulmonary hypertension) or when there are other associated cardiac defects, cardiac catheter study may need to be performed.
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