What is Ventricular Septal Defect (VSD)

It is a type of congenital heart disease, in which there is a defect (hole) in the ventricular septal, causing the blood flow from the left ventricle to the right ventricle and oxygenated blood goes back to the lungs through the right ventricle.


• Commonly congenital (most common congenital heart disease).
• Acquired—rupture of interventricular septum after acute myocardial infarction, rarely

Site of VSD

Common in perimembranous part of intraventricular septum (in 90% cases).


Vary with the size of VSD—3 types according to the size.
• Small (maladie de Roger)—It is asymptomatic, closes spontaneously. The systolic murmur
is loud and prolonged.
• Moderate—Patient presents with fatigue and dyspnoea.
• Large—The murmur is soft.

Clinical Features


• May be asymptomatic.
• Breathlessness, palpitation, fatigue, weakness.


In Precordium
Inspection: Visible cardiac impulse in left parasternal area.
Palpation: Systolic thrill—in left parasternal area (4th or 5th intercostal space).
Auscultation: Pansystolic murmur in left parasternal area in 4th or 5th intercostal space.
NB: When there is reversal of shunt (called Eisenmenger’s syndrome), features of pulmonary
hypertension will be present (see later).


• Infective endocarditis (more common in small VSD).
• Pulmonary hypertension with reversal of shunt (Eisenmenger’s syndrome).
• Heart failure.


• ECG.
• X-ray chest shows cardiomegaly.
• Echocardiography, preferably colour Doppler.
• Cardiac catheterisation.
• CMR (cardiac magnetic resonance angiography) may be helpful.


1. Small VSD—Surgery is not needed, only follow-up. Prophylactic penicillin for SBE may be
2. Moderate to large VSD—Surgical correction.
3. When Eisenmenger’s syndrome develops—Surgery is contraindicated, as it aggravates rightsided
heart failure. Then, following treatments are given:
–– Diuretic.
–– Digoxin in some cases.
–– Venesection, especially if there is polycythaemia.
–– Heart lung transplantation may be done.