Q. Can you explain Restrictive Ventricular Septal Defect ?

VSD is restrictive when VSD pressure gradient is more than 60mmHg (systolic cuff pressure-VSD lpressure gradient = PA systolic pressure). PA systolic pressure can also be estimated Erom TR gradient. Tybulent jet is noticed in colour Doppler. VSOs are restrictive due to its smaller size or sometimes surrounding structur6s like tricuspid valve or aortic valve cover it partially. Whenever VSD is getting smaller due to aortic valve prolapse, aortic valve should be evaluated for incompetence and surgery should be advised at the right time so that valve cduld be preserved.