Ventricular Septal Defect
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- Congenital or acquired defect of the interventricular septum that allows communication of blood between the left and the right ventricles
- Other than bicuspid aortic valve, this is the most common congenital heart malformation reported in infants and children. It also occurs as a complication of acute myocardial infarction (MI).
- Blood flow across the defect typically is left to right and depends on the size of the defect and the pulmonary vascular resistance (PVR).
- Prolonged shunting of blood can lead to pulmonary hypertension (HTN) and eventual reversal of flow across the defect, as well as to cyanosis (Eisenmenger complex).
- System(s) affected: Cardiovascular
In this population, almost entirely associated with MI
- Pregnancy may exacerbate symptoms and signs of a ventricular septal defect (VSD).
- Tolerated during pregnancy if the septal defect is small
- May be associated with an increased risk of preeclampsia in women with an unrepaired VSD (1)
- Predominant sex: No gender predilection
- Males are affected more than females if associated with MI.
- Occurs in ∼2/1,000 live births (2)
In the US:
- Acute MI: Estimated to complicate 1–3%
- Lowered prevalence in adults due to spontaneous closure of defects
- Risk of sibling being affected: 4.2%
- Risk of offspring being affected: 4%
- Postacute MI:
- First MI
- Limited coronary artery disease
- Most frequent within 1st week after MI
- Occurs in 1–3% of MIs, most commonly after anterior MI
Multifactorial etiology; autosomal-dominant and -recessive transmissions have been reported.
For adults, avoid risk factors for MI and obtain evaluation before pregnancy.
- In adults, secondary to MI
Commonly Associated Conditions
- 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