Spectrum Of Adult

A simplified summary of the major types of the major adult CHD are listed in Table 5.

Mitral valve prolapse, BAVs (and congenital forms of aortic stenosis), patent foramen ovale, atrial septal defects, and Marfan syndrome have been discussed previously, and are not covered in this chapter.

Isolated Ventricular Septal Defect

• Ventricular septal defects (VSDs) are the commonest congenital heart defect in children.

Right upper _ pulmonary vein
Apical 4-Chamber (apex down)
Fig. 6. Subcostal and apical views (apex down orientation) for segmental analysis. The standard echocardiography examination should be preceded by subcostal and apical (often displayed anatomically correct apex down) views to analyze cardiac situs and cardiac segment connections.

• Most smaller defects close spontaneously, but isolated VSDs make up approx 10% of all adult CHD.

Anatomical Sites

Ventricular septal defects occur in a number of anatomic sites, including the membranous septum, inlet septum, outlet septum, and trabecular septum (Figs. 9 and 10). Perimembranous VSDs (~80%) may extend to other areas of the septum, but often close spontaneously (usually located by the septal leaflet of tricuspid valve [TV]). Ventricular septal defects can result in significantly increased flow through the pulmonary artery, with resultant pulmonary hypertension. In cases where pulmonary pressures reach left ventricular systolic pressures, the patient is considered to have "Eisenmenger's" physiology.

Best Echo Windows

• Parasternal long axis, PSAX, apical four chamber, apical five chamber, subcostal 4C (Table 6).

• TEE-midesophageal 4C, right ventricular outflow tract (RVOT) views for infundibular/conal septum.

Table 6

Recommended Echocardiography Windows for Ventricular Septal Defects

Perimembranous

PLAX, PSAX (10 o'clock), A5C

Inlet/posterior-AV

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