Ventricular Septal Defect
Basics
Description
- Congenital (usually) or acquired defect in 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 late 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 late complication of 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, late 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 cyclooxygenase [COX] inhibitors, 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
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Domino, Frank J., et al., editors. "Ventricular Septal Defect." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688727/all/Ventricular_Septal_Defect.
Ventricular Septal Defect. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688727/all/Ventricular_Septal_Defect. Accessed December 12, 2024.
Ventricular Septal Defect. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688727/all/Ventricular_Septal_Defect
Ventricular Septal Defect [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688727/all/Ventricular_Septal_Defect.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Ventricular Septal Defect
ID - 1688727
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688727/all/Ventricular_Septal_Defect
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -