Overview Snapshot A 6-year-old girl is referred to a cardiologist for an evaluation of a heart murmur. She is healthy and has reached all developmental milestones. On exam, the precordium is hyperdynamic with a prominent right ventricular heave. A soft murmur is present in the pulmonic position (LUSB), and the second heart sound has persistent splitting during inspiration and expiration. An echo is shown. Introduction Characterized by a hole in the atrial septum 2nd most common congenital heart lesion VSD is most common Predisposes patient to CHF 2nd/3rd decades of life stroke due to paroxysmal embolus Presentation Symptoms asymptomatic in youth often discovered on routine school health exams mild fatigue frequent respiratory infections Physical exam midsystolic ejection murmur loud S1 wide fixed-split S2 heaving cardiac impulse (LLSB) Evaluation Echocardiogram is definitive shows defect in atrial septum EKG most commonly right-axis deviation CXR cardiomegaly increased pulmonary vascularity Differential PDA, VSD, CHF Treatment Nonoperative observation indicated in small symptomatic lesions medical management treat symptoms of CHF prior to definitive surgical correction Operative surgical patching indications larger lesions females repair required due to additional cardiovascular stress during pregnancy CHF symptoms present Prognosis, Prevention, and Complications Prognosis good to excellent in most cases poor in large lesions if left untreated Prevention no preventive measures are available for congenital defect treatment can decrease severity of CHF symptoms Complications Eisenmenger's syndrome pulmonary hypertension right ventricular hypertrophy reversal to a right-to-left shunt