A defect 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 the 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 catheterisation
- cardiac CT scan
congenital: medium or large
Kul Aggarwal, MD, MRCP, FACC
Professor of Clinical Medicine
University of Missouri
KA declares that he has no competing interests.
Dr Kul Aggarwal would like to gratefully acknowledge Professor Zuhdi Lababidi, a previous contributor to this topic.
ZL declares that he has no competing interests.
Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP
Department of Cardiology
Royal Children's Hospital
MC declares that he has no competing interests.
Sachin Khambadkone, MD, DCH, DNB
Consultant Paediatric Cardiologist and Honorary Senior Lecturer
Great Ormond Street Hospital and Institute of Child Health
SK declares that he has no competing interests.
Tain-Yen Hsia, MD
Attending Pediatric Cardiothoracic Surgeon
Medical University of South Carolina Children's Hospital
TYH declares that he has no competing interests.
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- 2020 adult congenital heart disease
- 2018 AHA/ACC guideline for the management of adults with congenital heart disease
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