Ventricular septal defects are defects in the interventricular septum that allows shunting of blood between the left and right ventricles.
Usually congenital, but rarely acquired after myocardial infarction or trauma.
May be associated with other congenital defects such as tetralogy of Fallot.
Significant left-to-right shunting results in pulmonary hypertension, which, if left untreated, can progress to shunt reversal with cyanosis and Eisenmenger's syndrome.
Small shunts may close spontaneously in childhood and can be managed by observation.
Large shunts require surgical closure.
Ventricular septal defects (VSDs) are congenital or acquired defects in the inter-ventricular septum that allow shunting of blood between the left and right ventricles. Eisenmenger's syndrome is shunt reversal (blood flowing from the right to the left ventricle) leading to the distribution of de-oxygenated blood to the systemic arterial circulation.
History and exam
Key diagnostic factors
- presence of risk factors
- systolic murmur left parasternal region
- failure to thrive
- shortness of breath
Other diagnostic factors
- recurrent pulmonary infections
- loud pulmonary component of the second heart sound
- finger clubbing
- recent myocardial infarction (usually within 2-5 days)
- recent trauma
- family history of congenital heart disease
- Down's syndrome (trisomy 21)
- maternal alcohol consumption during pregnancy
1st investigations to order
- chest x-ray
Investigations to consider
- cardiac MRI
- cardiac CT scan
- cardiac catheterisation
congenital: medium or large
- Atrial septal defect
- Patent ductus arteriosus
- Mitral regurgitation
- Advances in managing transition to adulthood for adolescents with congenital heart disease
- 2020 ESC guidelines for the management of adult congenital heart disease
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