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Perimembranous VSD is the commonest type of ventricular septal defect noted in children. Large VSDs can be associated with heart failure in infancy and may need surgery. Device closure is not that well established in perimembranous VSD as in case of muscular VSD.
Diagrammatic representation of VSD Eisenmenger. The other Eisenmenger syndromes are not called Eisenmenger complex, only VSD Eisenmenger is called Eisenmenger complex. Large ASDs usually develop Eisenmenger syndrome, may be after decades, not like early development of Eisenmenger syndrome in VSD and PDA.
In VSD Eisenmenger and PDA Eisenmenger, you would not expect right atrial enlargement. In VSD and PDA Eisenmenger, the heart size decreases when pulmonary hypertension develops, due to decrease in the shunt. In ASD, shunt is decreasing in Eisenmenger but right atrial enlargement is a component for cardiomegaly.
For example, when the VSD is small, the pressure difference between the right and left ventricles is high. Colour Doppler echocardiography is very useful in giving a quick visual assessment of regurgitation and stenosis of heart valves. It will also show abnormal flows as in an atrial or ventricular septal defect.
The VSD is partly overrided by the aorta. I am sure that most of you are familiar with echocardiography would have come at the diagnosis and differential diagnosis by this time because it is a very simple view. And this is a better annotated view and I am showing the ventricular septal defect here. Right ventricle, left ventricle.
But in a VSD with pulmonary hypertension A wave is not prominent. It will not occur in the presence of a large VSD which equalizes both right ventricular and left ventricular pressures. Right atrial hypertrophy as in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension.
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