Ventricular Septal Defect

A ventricular septal defect (VSD) is a hole between the ventricles. They are characterized into anatomic types based on their location relative to the components of the right ventricle and their anatomic borders. This chapter discusses the management of isolated VSDs and those associated with persistent patency of the arterial duct, coarctation of the aorta, and acquired aortic insufficiency. It is the size of the VSD, along with the pulmonary vascular resistance, that determines the magnitude of the left-to-right shunt. Other factors include ventricular compliance and obstructions to pulmonary or aortic outflows. Patients with restrictive VSDs are generally diagnosed by the discovery of a loud holosystolic murmur heard best at the left sternal border, rarely accompanied by a hyperactive precordium and a ventricular bulge. Medical management is directed at the pathophysiologic consequences of the left-to-right shunt, the management of increased pulmonary vascular resistance, and prophylactic antibiotic administration for endocarditis.