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Ventricular Septal Defects

  • Grace C. KungEmail author
  • Pierre C. Wong
Chapter

Abstract

The term “ventricular septal defect” (VSD) denotes a gap or opening in the ventricular septum. There are several anatomically distinct types of VSDs, differing both in morphology as well as location within the ventricular septum. Transesophageal echocardiography (TEE) plays a very important role in the evaluation of VSDs, primarily in the intraoperative setting, as a method of monitoring surgical VSD closure. In addition, TEE also provides essential information and guidance during device closure of certain types of VSDs, either in the cardiac catheterization laboratory or via the perventricular approach. This chapter discusses the anatomy and morphology of the different types of VSDs, along with their echocardiographic evaluation by TEE.

Keywords

Heart defects Congenital Heart septal defects Ventricular septal defect Echocardiography Transesophageal echocardiography Pediatric cardiac surgery 

Supplementary material

Video 9.1

Mid esophageal four chamber view (multiplane angle 0°) of a perimembranous ventricular septal defect partially occluded by tricuspid valve aneurysmal tissue, using both two dimensional imaging as well as and color flow doppler (MPG 2864 kb)

Video 9.2

Mid esophageal right ventricle inflow-outflow view, multiplane angle 53°, with anteflexion of the TEE probe. This view, which is comparable to an inverted transthoracic parasternal short axis view, shows a large perimembranous ventricular septal defect with aneurysmal tricuspid valve tissue, using both two dimensional imaging as well as and color flow Doppler (MPG 2409 kb)

Video 9.3

Mid esophageal four chamber view (multiplane angle 0°) of a large inlet ventricular septal defect, using both two dimensional imaging as well as and color flow Doppler (MPG 3714 kb)

Video 9.4a

Mid esophageal four chamber view (multiplane angle 0°) of a moderate size mid-muscular ventricular septal defect, using both two dimensional imaging as well as and color flow Doppler (MPG 1717 kb)

Video 9.4b

Mid esophageal four chamber view (multiplane angle 0°) of a mid-muscular ventricular septal defect in a patient with D-transposition of the great arteries, using both two dimensional imaging as well as and color flow Doppler. Note the flow by color Doppler from the right ventricle to the left ventricle (MPG 2395 kb)

Video 9.5

Mid esophageal four chamber view (multiplane angle 0°) of a small apical ventricular septal defect which was difficult to appreciate by two dimensional imaging, but was easily seen with color flow Doppler (MPG 1717 kb)

Video 9.6

Mid esophageal four chamber view (multiplane angle 0°) of a large perimembranous ventricular septal defect as well as smaller additional muscular defects, as seen by two dimensional imaging as well as and color flow Doppler (MPG 7929 kb)

Video 9.7

Larger inlet/muscular and apical ventricular septal defects, as noted from the Mid esophageal four chamber view (multiplane angle 0°) and retroflexion of the TEE probe. Both two-dimensional imaging and color flow Doppler are used (MPG 7658 kb)

Video 9.8

Mid esophageal long axis view (105–122°) to mid esophageal right ventricle inflow-outflow view (27°) sweep of a perimembranous ventricular septal defect with attention to the right ventricular outflow tract. With probe retroflexion and a multiplane angle of 27°, the defect is easily seen and appears partially covered by tricuspid valve tissue (MPG 4580 kb)

Video 9.9

Mid esophageal 0° and 90° views of a supracristal ventricular septal defect, showing both two-dimensional imaging and color flow Doppler (MPG 6810 kb)

Video 9.10

Mid esophageal modified aortic valve short axis (0°) and long axis (88–103°) views of a malalignment ventricular septal defect in a patient with tetralogy of Fallot. The aortic valve overrides the ventricular septum by approximately 50 % and forms the “roof” of the defect (MPG 6804 kb)

Video 9.11

Deep transgastric sweep of a perimembranous ventricular septal defect from a sagittal (90°) to long axis (13°) plane, as noted by two-dimensional imaging (MPG 2477 kb)

Video 9.12

Double chamber right ventricle (RV) as seen first from a modified mid esophageal RV inflow-outflow view (multiplane angle 75°) and then from a deep transgastric sagittal view (multiplane angle about 70°). Note the prominent muscle bundles and mid-cavitary RV narrowing (shown by *). The mid esophageal view also shows left to right shunting across a perimembranous ventricular septal defect. Ao aortic valve, PA pulmonary artery, RVOT right ventricular outflow tract (MPG 18464 kb)

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Division of Cardiology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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