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Ventricular Septal Defect

Ventricular Septal Defect is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Congenital or acquired defect of the interventricular septum that allows communication of blood between the left and the right ventricles
  • Second most common congenital heart malformation reported in infants and children. It can also occur as a complication of acute myocardial infarction (MI).
  • Severity of the defect is correlated with its size, with large defects being the most severe.
  • Blood flow across the defect typically is left to right, depending on defect size and pulmonary vascular resistance (PVR).
  • Prolonged left to right shunting of blood can lead to pulmonary hypertension (HTN). This may eventually lead to a reversal of flow across the defect and cyanosis (Eisenmenger complex).

Geriatric Considerations
Almost entirely associated with MI

Pediatric Considerations
Congenital defect

Alert
  • Pregnancy may exacerbate symptoms and signs of a ventricular septal defect (VSD).
  • Can be tolerated during pregnancy if VSD is small
  • May be associated with an increased risk of preeclampsia in women with an unrepaired VSD

Epidemiology

Incidence
  • Congenital defect: no gender predilection, occurs in ~2/1,000 live births and accounts for 30% of all congenital cardiac malformations
  • Post-MI: Some studies suggest that gender may play a role.

Prevalence

In the United States:

  • Occurs in ~ 50% of all children with congenital heart disease
  • Low prevalence in adults (~0.3 per 1,000) due to spontaneous closure
  • Post-MI complication in ~0.2–3% of cases

Etiology and Pathophysiology

  • Congenital
  • In adults, complication of MI
  • Some reports of iatrogenic causes

Genetics
Multifactorial etiology; autosomal dominant and recessive transmissions have been reported.

Risk Factors

  • Congenital VSD:
    • Risk of sibling being affected: 4.2%
    • Risk of offspring being affected: 4%
    • Prematurity
  • Post-MI VSD:
    • Advanced age
    • Arterial HTN
    • First MI
    • Most frequent within 1st week after MI
    • Most commonly after anterior wall acute MI

General Prevention

Avoid prenatal exposure to known risk factors (ibuprofen, marijuana, organic solvents, febrile illness). For adults, avoid risk factors for MI and obtain evaluation before pregnancy.

Commonly Associated Conditions

  • Congenital:
    • Tetralogy of Fallot
    • Aortic valvular deformities, especially aortic insufficiency and bicuspid aortic valve
    • Down syndrome (trisomy 21), endocardial cushion defect
    • Transposition of great arteries
    • Coarctation of aorta
    • Tricuspid atresia
    • Truncus arteriosus
    • Patent ductus arteriosus
    • Atrial septal defect
    • Pulmonic stenosis
    • Subaortic stenosis
  • Adult: coronary artery disease

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Citation

Stephens, Mark B., et al., editors. "Ventricular Septal Defect." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116644/all/Ventricular_Septal_Defect.
Ventricular Septal Defect. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116644/all/Ventricular_Septal_Defect. Accessed April 24, 2019.
Ventricular Septal Defect. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116644/all/Ventricular_Septal_Defect
Ventricular Septal Defect [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116644/all/Ventricular_Septal_Defect.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ventricular Septal Defect ID - 116644 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116644/all/Ventricular_Septal_Defect PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -