Ventricular septal defect

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Target exams

Red flags

• A previously well infant who becomes increasingly breathless, sweaty on feeds and fails to thrive at four to eight weeks is in pulmonary overcirculation from a moderate-to-large VSD as pulmonary vascular resistance falls — assess urgently with echocardiography and start heart-failure therapy
• Cyanosis, clubbing or a right-to-left shunt in an older child or adult with a VSD signals Eisenmenger syndrome — the pulmonary vascular disease is now fixed, and closing the defect is harmful and potentially fatal
• Aortic regurgitation developing in a child with a perimembranous or outlet VSD means aortic cusp prolapse and is an indication to close the defect, even if the shunt is small
• Surgical closure carries a risk of complete heart block from injury to the atrioventricular node; a new bradycardia after VSD repair needs urgent assessment

Life stages

Care settings

Clinical exam formats

Board mappings

• Ventricular septal defect
• Ventricular septal defect and left-to-right shunt physiology
• Ventricular septal defect: murmur recognition, natural history, and management
• Short case: systolic murmur in an infant (VSD)
• Long case: the child with a repaired VSD and follow-up
• Ventricular septal defect: anatomy, haemodynamics, and management
• Cardiac: systolic murmur in an infant
• Congenital heart disease: ventricular septal defect
• Patient Care: congenital heart disease, including ventricular septal defect
• Medical Expert: ventricular septal defect