CHAPTER 1

INTRODUCTION

1.1 Background

Ventricular septal defect (VSD) is the most common congenital heart disease,
it was more than 15-20% of congenital heart disease.(Myung k.park,2008
pediatric cardiology).Ventricular septal defect (VSD) is an abnormal
communication between the right and left ventricles. The ventricular septum is
normally a solid wall completely separating the 2 ventricles. Presentation of
patients with VSD vary depending on size of defect and consequently extent of
left to right shunting of blood. Patients with VSD are typically recognized early in
life due to the loud murmur it produces.1 VSD has four components: the
membranous septum, the inlet septum(muscular), the trabecular septum(muscular)
and the outlet (infundibular/subaterial) septum with most common defect is at
perimembranous(70%).1
Centers for Disease Control and Prevention, Vsd that happen in america is
equal as vsd that happen in the world, approximately one to two case in one
thousand birth. Research shows that VSD prevalence has increase in the last thirty years.
Perimembranous is the most common VSD found in Indonesia (60%), follows by subarterial
(37%), especially in Rumah Sakit Jantung Harapan Kita, and occasionally muscular type(3%).
VSD is often found with other congenital disease, e.g. Down Syndrome. 4
Marasmus is usually accepted as meaning a chronic state of malnutrition of a
severe grade and is associated in our minds with a definite clinical picture.
Marasmus is a situation where a child is deficient in energy and protein as well.
Etiology of marasmus is : 1. Improper feeding. 2. Infection-e.g., pyelitis, otitis
media, toxasmias of the new-born. Syphilis and tuberculosis may produce this
picture, and are mentioned in view of the importance of differentiating these from
the more purely nutritional type. 3. Congenital weakness of disease-e.g.,
prematurity, congenital heart disease. 4. Defective hygiene.3
 Marasmus is a serious worldwide problem that involves more than 50 million
children younger than 5 years. Accoding to the World Health Organization
(WHO), 49% of the 10,4 million deaths occuring in children younger than 5 years
in develoving countries are associating with protein energy malnutrition (PEM).7
Moreover in developing country like indonesia, prevalance of marasmus is
still high.5 Defisiency in calories and energy (malnutrion) is one of the
maincproblem in indonesia. It has highest prevalence in children younger than 5
years old. Based on riskesdas 2007, children who suffer malnutrion is 5,4%.6
 CHAPTER II
LITERATURE REVIEW\

2.1 DEFINITION

Ventricular septal defect (VSD) is an abnormal communication between the

right and left ventricles. The ventricular septum is normally a solid wall
completely separating the 2 ventricles. Presentation of patients with VSD vary
depending on size of defect and consequently extent of left to right shunting of
blood. Patients withVSD are typically recognized early in life due to the loud
murmur it produces. (Omar M. Khalid and Ra-id Abdulla)
 DAFTAR PUSTAKA

1. Ra-id Abdulla, Omar M. Khalid, (2011) Heart Diseases in Children.

2.Park, M. K. (2008). pediatric cardiology.

3. Wilfred j. Pearson, d.s.o., m.c., m.d. Oxf., m.r.c.p. Lond., Marasmus. Available
from: http://pmj.bmj.com/content/1/9/129.full.pd. [accessed 18 april 20016]

4. Rilantono LI. Defek septum ventrikel. Dalam: Rilantono LI, Baraas F, Karo SK,Roebiono PS,
editor. Buku ajar kardiologi. Jakarta: Fakultas Kedokteran UniversitasIndonesia; 2008. h. 232-5.

5.Rebinowith,S.2014.Marasmus..[internet]. Medscape.2014 [cited May 13,2014]. Availablefrom

http;// emedicine.medscape.com/article. [accessed 19 april 20016]
6. Riset Kesehatan Dasar,2013.Riskesdar 2013 dalam angka. Badan penelitian dan
pengembangan kesehatan, Kementrian Kesehatan RI.

7. Unicef, 2014. Marasmus. Available from:

www.unichef.org/nutrition/training/2.3.4.html. [accessed 19 april 20016]