Ventricular Septal Defect

Pathogenesis of ventricular and atrial septal defects. (A) The common atrial chamber is being separated into the right and left atria (RA and LA) by the septum primum. Because the septum primum has not yet joined the endocardial cushion material, there is an open ostium primum. The ventricular cavity is being divided by a muscular interventricular septum into right and left chambers (RV and LV). SVC, superior vena cava; IVC, inferior vena cava. (B) The septum primum has joined the endocardi...

Trisomy 21 in the karyotype of a child with Down syndrome. All other chromosomes are normal.

A. Translocation of the long arms of chromosomes 14 and 21 at the centromere. Loss of the short arms is not clinically significant, and these individuals are clinically normal, although they are at risk for producing offspring with unbalanced translocations. B. Karyotype of translocation of chromosome 21 into 14, resulting in Down syndrome.

Coronal view of the heart with a congenital ventricular septal defect. Oxygenated blood is allowed to travel from the left to right ventricle into the pulmonary trunk.

<bold>Figure 33-39</bold> Echocardiogram 4 chamber view with color Doppler analysis demonstrates an apical musular ventricular septal defect. (LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; VSD, ventricular septal defect.)

Acute infero-postero myocardial infarction.

<bold>Fig CA 13-5 Ventricular septal defect.</bold> The pulmonary trunk is very large and overshadows the normal-sized aorta, which seems small by comparison. The pulmonary artery branches in the hilum and in the periphery of the lung are enlarged, and the pulmonary vascular volume is increased. The heart is enlarged and somewhat triangular.¹

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

A case of complex congenital heart disease. Patient has situs inversus, dextrocardia, is status-post tetralogy of Fallot repair, and presents with symptoms of right-sided heart failure. A: Axial gradient echo images showing dextrocardia and right ventricular dilation. B: Sagittal gradient-echo images showing free pulmonary regurgitation (arrow) at the site of previous infundibular resection.

<bold><italic>Figure 13-21</bold> Ventricular septal defect.</bold> This defect is at the upper end of the interventricular septum.

<bold><italic>Figure 13-22</bold> Tetralogy of Fallot: a right-to-left cardiac shunt.</bold> The defects are: 1) misplacement (rightward shift) of the aortic valve so that the aortic orifice catches unoxygenated blood coming through the 2) ventricular septal defect in a right-to-left shunt because 3) pulmonary artery stenosis obstructs pulmonary blood flow, which increases right ventricular pressure, causing 4) right ventricular hypertrophy.

Auscultation, ventricular septal defect - A small ventricular septal defect causes a holosystolic murmur that often has a slight midsystolic accentuation. The second sound is not altered

Auscultation, ventricular septal defect - Moderate ventricular septal defect permits left-to-right shunting but maintains left-ventricular-to-right ventricular pressure gradient. The increased flow through the mitral valve causes an early diastolic "flow" (ventricular filling) murmur

Tetralogy of Fallot - Chest x-ray showing features of tetralogy of Fallot: diminished pulmonary vascularity, concave pulm. a., rt.aortic arch, and rt. descending aorta. Note oval-shaped heart w/ laterally displaced and elevated cardiac apex leading to "boot" shaped silhouette

Ventricular septal defect - Chest X-ray showing features of ventricular septal defect: increased pulmonary vascularity, moderate cardiomegaly, and left ventricular dilation producing "sagging" or "drooping" of the cardiac apex. Left atrial enlargement is also present

Ventricular septal defect - Removal of a portion of the r. ventricular wall revealing three types of septal defects: 1, membranous; 2, muscular; 3, subpulmonic

Acute anterior myocardial infarction. Transmural injury is manifested by ST-segment elevation of greater than 0.2 mV in leads V1 to V3.

Myocardial infarction, ST elevation.

<bold>FIGURE 26-10</bold> (<bold>Top</bold>) (<bold>A</bold>) ECG tracing showing normal P, Q,R,S, and T waves. (<bold>B</bold>) ST elevation with acute ischemia. (<bold>C</bold>) Q wave with acute myocardial infarction. (<bold>Bottom</bold>) Current-of-injury patterns with acute ischemia. With predominant subendocardial ischemia (<bold>A</bold>), the resultant ST segment is directed toward the inner layer of the affected ventricle and the ventricular cavity. Overlying leads therefore record ST-segment depression. With ischemia inv...

Acute myocardial infarct. A cross-section of the ventricles of a man who died a few days after the onset of severe chest pain shows a transmural infarct in the posterior and septal regions of the left ventricle. The necrotic myocardium is soft, yellowish, and sharply demarcated.