From the Guidelines
The knee-to-chest position is not a recommended intervention for improving hypotension in cases of Ventricular Septal Defect (VSD). In VSD, hypotension occurs due to left-to-right shunting of blood through the septal defect, reducing systemic cardiac output 1. The management of VSD typically involves medical therapy, with the goal of reducing symptoms and preventing complications. According to the 2018 AHA/ACC guideline for the management of adults with congenital heart disease, small restrictive defects of the muscular or membranous septum may be watched conservatively without need for operative intervention 1.
Key Considerations
- The knee-to-chest position is more commonly used for conditions like tetralogy of Fallot during hypercyanotic spells, where it increases systemic vascular resistance and reduces right-to-left shunting.
- For VSD patients experiencing hypotension, maintaining a normal supine position while receiving appropriate medical therapy and oxygen supplementation is more beneficial, as the pathophysiology involves excessive pulmonary blood flow rather than inadequate pulmonary circulation.
- Medical therapy for VSD-related hypotension may include diuretics, afterload reducers, and inotropic support, depending on the severity of the condition and the patient's response to treatment.
Management of VSD
- The 2018 AHA/ACC guideline recommends that small restrictive defects of the muscular or membranous septum may be managed by observation without need for operative intervention 1.
- Larger defects may be repaired, but only in the absence of severe pulmonary arterial hypertension (PAH) and severely elevated pulmonary vascular resistance, as the presence of these conditions incurs a high perioperative risk 1.
- Trans-catheter device occlusion of muscular and perimembranous VSD is feasible, and trials have demonstrated a good safety and efficacy profile 1.
From the Research
Hypotension in Ventricular Septal Defect (VSD)
- Hypotension is a common issue in patients with VSD, particularly in those with large defects or those who have undergone device closure procedures 2.
- The management of hypotension in VSD patients often involves the use of fluids, inotropes, and vasopressors, although these treatments can have varying effects on hemodynamics 3.
- In some cases, percutaneous mechanical circulatory support (MCS) devices, such as Impella, may be used to improve forward blood flow and arterial pressure in patients with VSD 3.
Knee to Chest Position
- There is no direct evidence in the provided studies to suggest that the knee to chest position improves hypotension in cases of VSD.
- The studies primarily focus on the diagnosis, management, and treatment of VSD, including surgical and percutaneous closure procedures, as well as the use of MCS devices 3, 4, 2, 5, 6.
- The knee to chest position is not mentioned as a treatment or intervention for hypotension in VSD patients in any of the provided studies.
Treatment of VSD
- The treatment of VSD depends on the size, location, and number of defects, as well as the patient's symptoms and overall health 4, 6.
- Surgical closure is often recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse 4, 6.
- Percutaneous closure procedures, such as the use of the Amplatzer Muscular VSD Occluder, may be used for large muscular VSDs 4, 6.