Ventricular septal defect

This is a defect in the ventricular septum. The defect can occur in the outlet, perimembranous, inlet or trabecular septum. It can vary in size or occur in more than one site in the same heart. It is one of the most common forms of congenital heart disease although it is seen much less commonly in the fetus than in postnatal life. A VSD is a common component of more complex forms of congenital heart disease, when the associated lesion will usually dominate the mode and timing of presentation. In addition, the presence of a large VSD can alter the prognosis in, for example, coarctation of the aorta. An outlet VSD is the characteristic VSD of the tetralogy of Fallot or a common arterial trunk; an inlet VSD is part of an atrioventricular septal defect. Although an inlet VSD usually occurs as part of a canal defect, it can be isolated. Inlet and outlet VSDs rarely close spontaneously, whereas perimembranous and trabecular defects commonly do. If the VSD is isolated and small, the child will present with an asymptomatic murmur. It has a high chance of closing spontaneously in the first years of life. If it is large (greater than half the aortic root size), the neonate will present with evidence of cardiac failure or failure to thrive. Most defects can be managed medically although intractable cardiac failure or pulmonary hypertension are reasons for surgical intervention in the first year of life. .