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
- 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).
Almost entirely associated with MI
- 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
- 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.
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
- In adults, complication of MI
- Some reports of iatrogenic causes
Multifactorial etiology; autosomal dominant and recessive transmissions have been reported.
- Congenital VSD:
- Risk of sibling being affected: 4.2%
- Risk of offspring being affected: 4%
- Post-MI VSD:
- Advanced age
- Arterial HTN
- First MI
- Most frequent within 1st week after MI
- Most commonly after anterior wall acute MI
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
- 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