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I have my name is Sanjay Gupta I'm a consultant cardiologist in York today I wanted to do a video on BSDs ventricular septal defects okay VSD is a common type of hole in the heart okay let me just show you so here is the heart this is the left ventricle this is the right ventricle here this is the septum and basically a VSD is a hole which connects the left heart to the right are the left ventricle to the right ventricle the hole through this septum that's what a VSD is now BSDs can be congenital and in fact most of them are meaning that you're born with them, or they can be acquired which means that that something happens to the heart like a heart attack and that causes damage to this part of the heart muscle and that can then cause a hole to develop, so they can be acquired but the majority of them are congenital its worth note noting that they can occur at any point along this septum this ventricular septum, and they can be isolated they can be one, or they can be multiplied the most important determinant of how important how what the VSD means for the patient is the size of the VSD the hole the size of the hole the bigger the hole the bigger the problems associated with it the smaller the hole the less likelihood of problems having a hole has lots of implications particularly a VSD having a VSD has lots of implications on the heart in general, and I'll try and go through them one at a time the first thing to understand is that what will happen is the heart is usually the left heart will usually pump blood through the aorta ve lop around the heart if you have a hole in the heart then what will happen is as this part of the heart tries to contract the blood instead of all going out into the body some of it will go through the hole into the right heart and therefore the rest of the body will get less blood than it is used to what this then means is that the kidneys which are very sensitive to any reduction in blood volume will think the patient is dehydrated and a series of things happen within the kidneys which mean that the kidneys can then absorb more water from the urine and to try and restore the circulating volume, so the kidneys will absorb more volume and therefore try and restore this volume so what that then means is that there's more volume in the whole system right because we were never dehydrated it was just that part of the blood was going somewhere else and not getting to the kidneys so let's say you the ventricle contracts and 20 leaks back into the right heart, so the kidneys will only get 80, so the kidneys will then aim to absorb 20 from the urine and therefore restore the circulating volume but now what you have is a problem where you have a hundred and twenty percent you don't have 100 because that 20 had just leaked backs in the system you have one hundred and twenty percent and therefore what will then happen is more blood will leak through PO, and therefore you can get into a vicious cycle and the consequence of getting...
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