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Ventricular septal defects

Last reviewed: 1 Apr 2025
Last updated: 07 Jun 2024

Summary

Definition

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
Kul Aggarwal

Professor of Clinical Medicine

University of Missouri

Columbia

MO

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

UK

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

SC

Disclosures

TYH declares that he has no competing interests.

References

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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.
  • Ventricular septal defects images
  • 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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