Mechanisms of improvement of heart failure in young children with ventricular septal defect. If a child with ventricular septal defect (VSD) and heart failure improves, what are the possibilities? Spontaneous decrease in size of VSD: This is the best natural course and needs no further treatment. Development of right ventricular outflow tract (RVOT) obstruction: This is the next best possibility which could have occurred when the heart failure has decreased. This can progress to a Tetralogy of Fallot like physiology with right to left shunting across the VSD and is known as Gasul variant or Gasul phenomenon. Still it can be remedied by surgical treatment. VSD closure and resection of RVOT are needed. Development of pulmonary vascular disease: This is the worst scenario which could have occurred when the heart failure has decreased in a case of VSD. Here the options are limited as it progresses to Eisenmenger physiology and no curative therapy can be offered other than heart lung transplant. How do you clinically differentiate these situations? Look for features of RVOT obstruction and pulmonary hypertension. When the defect decreases in size, pansystolic murmur becomes more prominent, but second sound is normal. The murmur ultimately disappears when the VSD closes. If RVOT obstruction develops, pulmonary component of second sound (P2) becomes softer. VSD murmur gets replaced by RVOT murmur. If pulmonary hypertension develops, P2 becomes loud and VSD murmur decreases and disappears. Cyanosis develops later due to right to left shunt. In all these situations, heart failure improves because pulmonary blood flow decreases.
Content
1.189 -> Mechanisms of improvement of heart failure
in young children with ventricular septal
6.46 -> defect.
9.29 -> If a child with ventricular septal defect
(VSD) and heart failure improves, what are
14.579 -> the possibilities?
17.61 -> Spontaneous decrease in size of VSD: This
is the best natural course and needs no further
26.63 -> treatment.
28.27 -> Development of right ventricular outflow tract
(RVOT) obstruction: This is the next best
33.329 -> possibility which could have occurred when
the heart failure has decreased.
39.089 -> This can progress to a Tetralogy of Fallot
like physiology with right to left shunting
45.1 -> across the VSD and is known as Gasul variant
or Gasul phenomenon.
51.35 -> Still it can be remedied by surgical treatment.
55.059 -> VSD closure and resection of RVOT are needed.
61.789 -> Development of pulmonary vascular disease:
This is the worst scenario which could have
66.97 -> occurred when the heart failure has decreased
in a case of VSD.
71.83 -> Here the options are limited as it progresses
to Eisenmenger physiology and no curative
78.76 -> therapy can be offered other than heart lung
transplant.
84.1 -> How do you clinically differentiate these
situations?
88.48 -> Look for features of RVOT obstruction and
pulmonary hypertension.
93.31 -> When the defect decreases in size, pansystolic
murmur becomes more prominent, but second
101.78 -> sound is normal.
103.7 -> The murmur ultimately disappears when the
VSD closes.
109.22 -> If RVOT obstruction develops, pulmonary component
of second sound (P2) becomes softer.
117.42 -> VSD murmur gets replaced by RVOT murmur.
122.7 -> If pulmonary hypertension develops, P2 becomes
loud and VSD murmur decreases and disappears.
131.56 -> Cyanosis develops later due to right to left
shunt.
136.11 -> In all these situations, heart failure improves
because pulmonary blood flow decreases.
