PATIENT: sam bewick 11602
HISTORY: asymptomatic grade 4 – 5 systolic murmur, PMI apex, right / sternal. Less than one year old, screen prior to anaesthesia
There is a perimembranous VSD here, high in the ventricular septum just beneath the aortic valve. the defect is very small and i could not measure the annulus but i would expect a defect of no more than 1-2mm, given this. This VSD is highly likely to be restrictive, given the high velocity of flow and pressure gradient (5.7m/s, 130mmHg) and the relatively normal left ventricular dimensions. These defects require no medication and have a low likelihood of becoming symptomatic, however potential sequelae include left sided volume overload and congestive failure (left, possibly right), systolic failure, pulmonary hypertension and consequent reversed shunting, and bacterial endocarditis due to chronic turbulent flow. This patient should be readily treated with antibiotics in the event of any surgery / wounds / infections etc throughout its life. Annual echocardiography would be prudent. With regards to anaesthesia, a suitable protocol should be sought from an anaesthetist / cardiologist.
Comments: the left ventricle appears slightly rounded however otherwise cardiac chambers, valves and outflow tracts appear normal and systolic function is good. Heart rate is approximately 100bpm, sinus rhythm; patient stressed, fractious, tense, wriggly, panting excessively; and the examination was stopped several times.
LV Index of Sphericity (normal >1.65) 1.15
LA:Aortic ratio (RPS SA, normal <1.6) 1.6
LA:Ao ratio (RPS LA, normal <2.5) 2.0
FS 24%, EPSS 0.1cm.
WALL THICKNESS AND CHAMBER DIMENSIONS COMMENTS: lvdd 3.46cm
turbulent jet projecting through the perimembranous ventricular septum just below the aortic valve, predominantly during systole but also smaller flow (red flame) during diastole, into the right ventricle.
MITRAL INFLOW: E 0.8m/s A 0.4m/s. Mitral Regurgitation? no
AORTIC OUTFLOW: Max Velocity 1.1m/s. Aortic Insufficiency? no
TRICUSPID INFLOW: Tricuspid Insufficiency? no
PULMONIC OUTFLOW Max Velocity 1m/s. Pulmonic Insufficiency? no
OTHER: jet into right ventricle 5.7m/s