Surgery in VSD after PHT
Why is surgery contraindicated in a patiend with VSD who has developed significant PHT ? why does it cause mortality and morbidity ? what can be done for them ?
Where can i find pictures of the diffent types of VSD ?
Answer:chocorocky - I would look up "Eisenmenger syndrome" in your textbook. This is the most worrisome complication of VSDs, ASDs, PDAs and other heart defects that create communications between the left and right sides of the heart. When an abnormal communication such as this exists, blood preferentially shunts from left to right because the resistance in the lungs is much lower than the resistance in the body. In the example of a VSD, blood will shunt across the defect from the left ventricle to the right ventricle and then out to the lungs. This leads to increased blood flow through the lungs.
Over time, the increased pulmonary blood flow causes injury to the pulmonary blood vessels. The blood vessels start to thicken, and later they become obstructed and break down. This causes increased pulmonary vascular resistance and, as a result, pulmonary hypertension. When this occurs, blood does not want to shunt left to right anymore since the pressures in the lungs become just as high or higher than it is in the body. When this happens, blood can start to shunt the OTHER way - in other words, blue blood will go across the VSD from the right ventricle to the left ventricle, thus bypassing the lungs. When this process occurs, we call it Eisenmenger syndrome.