Ventricular septal defects

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Jun 2025

Last updated: 07 Jun 2024

Ventricular septal defects (VSDs) are defects in the interventricular septum that allow 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 syndrome.

Small shunts may close spontaneously in childhood and can be managed by observation.

Large shunts require surgical closure.

Definition

VSDs are congenital or acquired defects in the interventricular septum that allow shunting of blood between the left and right ventricles.

Eisenmenger syndrome is shunt reversal (blood flowing from the right to the left ventricle) leading to the distribution of deoxygenated blood to the systemic arterial circulation.

History and exam

Key diagnostic factors

systolic murmur left parasternal region
faltering growth
shortness of breath

Full details

Other diagnostic factors

recurrent pulmonary infections
loud pulmonary component of the second heart sound
cyanosis
finger clubbing
recent myocardial infarction (usually within 3 to 5 days)
recent trauma

Full details

Risk factors

family history of congenital heart disease
Down syndrome (trisomy 21)
maternal alcohol consumption during pregnancy
maternal cigarette smoking during pregnancy

Full details

Diagnostic tests

1st tests to order

echocardiography
chest x-ray
ECG

Full details

Tests to consider

cardiac MRI
cardiac CT scan
cardiac catheterization

Full details

Treatment algorithm

ACUTE

congenital: small

congenital: medium or large

acquired

Contributors

Authors

Kul Aggarwal, MD, MRCP, FACC

Professor of Clinical Medicine

University of Missouri

Columbia

Disclosures

KA declares that he has no competing interests.

Acknowledgements

Dr Kul Aggarwal would like to gratefully acknowledge Professor Zuhdi Lababidi, a previous contributor to this topic.

Disclosures

ZL declares that he has no competing interests.

Peer reviewers

Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP

Acting Head

Department of Cardiology

Royal Children's Hospital

Melbourne

Australia

Disclosures

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

London

Disclosures

SK declares that he has no competing interests.

Tain-Yen Hsia, MD

Attending Pediatric Cardiothoracic Surgeon

Medical University of South Carolina Children's Hospital

Charleston

Disclosures

TYH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Stout KS, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Apr 2;139(14):e698-800.Full text Abstract

Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42(6):563-645.Full text Abstract

Expert Panels on Cardiac Imaging and Pediatric Imaging; Krishnamurthy R, Suman G, Chan SS, et al. ACR appropriateness criteria® congenital or acquired heart disease. J Am Coll Radiol. 2023 Nov;20(11s):S351-81.Full text Abstract

John AS, Jackson JL, Moons P, et al. Advances in managing transition to adulthood for adolescents with congenital heart disease: a practical approach to transition program design: a scientific statement from the American Heart Association. J Am Heart Assoc. 2022 Apr 5;11(7):e025278.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Atrial septal defect
- Patent ductus arteriosus
- Mitral regurgitation
More Differentials
Guidelines
- ACR appropriateness criteria: congenital or acquired heart disease
- Advances in managing transition to adulthood for adolescents with congenital heart disease
More Guidelines
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Ventricular septal defects

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

congenital: small

congenital: medium or large

acquired

Contributors

Authors

Kul Aggarwal, MD, MRCP, FACC

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP

Disclosures

Sachin Khambadkone, MD, DCH, DNB

Disclosures

Tain-Yen Hsia, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice