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.

Causes

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

Site of VSD

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

Types

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

Symptoms

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

Signs

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).

Complications

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

Investigations

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

Treatment

1. Small VSD—Surgery is not needed, only follow-up. Prophylactic penicillin for SBE may be
given.
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.