Yentricular Septal DefectRYSmallModerateLargeLargedefect(>1.Ocm)Moderate defect(0.5~Smalldefect(diametershunt/pulmonaryflow>601.Ocm),left to right<0.5cm),smallshunt%,LV,RV enlargement,shunt,pulmonaryflowincreased, LALVpulmonary hypertensionand no obviousenlargement,ordoubledouble shunt or R to L,abnormality inventricleenlargementfinally,Eisenmenger'shemodynamicshypertension inRV,PAsyndrom
Smalldefect(diameter <0.5cm)，small shunt and no obvious abnormality in hemodynamics Moderate defect(0.5～ 1.0cm)，left to right shunt,pulmonary flow increased，LA 、 LV enlargement ,ordouble ventricleenlargement hypertension inRV, P A Large defect(>1.0cm)， shunt/pulmonary flow> 60 ％，LV,RV enlargement， pulmonary hypertension double shunt or R to L， finally , Eisenmenger’s syndrom
LARAenlargeVSDEnlargeLVRVhypertrophyEnlargeBloodvolumehypertrophySystemic cirBlood-supplyPA enlargeinsufficientPulmonary cirFlow volume
RA LA enlarge LV Enlarge hypertrophy PA enlarge Systemic cir Blood-supply insufficient VSD RV Blood volume Enlarge hypertrophy Pulmonary cir Flow volume
Pathophysiology and HemodynamicsLALVenlargementandhypertrophyRVflow increased、enlargement、hypertrophyPulmonarycirculation flowincreased? Systemic circulation flow insufficiency
Pathophysiology and Hemodynamics LA,LV e n la rg e m e n t a n d h yp ertrop h y RV flow in crea s ed、e n la rg e m e n t、h yp ertrop h y P u lmon a ry circulation flow in crea sed Systemic circulation flow insufficiency
Clinical ManifestationsTwo determinants for clinicalmanifestation of isolatedvSDsizeofdefectvolumeof shunt
Clinical Manifestations Two determinants for clinical manifestation of isolated VSD size of defect volume of shunt
Clinical ManifestationsSmall vSD:no obvious symptomsModerate vSD:Symptoms:shortness of breath after cryor sucking in infant;dyspnea afterexercise,heartthrob（心悸），chest distress，growingdevelopment backward,andrespiratory tract infectionrepeatedly in senior
Clinical Manifestations Small VSD: no obvious symptoms Moderate VSD: Symptoms:shortness of breath after cry or sucking in infant; dyspnea after exercise,heartthrob(心悸),chest distress, growing development backward,and respiratory tract infection repeatedly in senior