pediatrics
Ventricular Septal Defect (VSD)
Key Points
A ventricular septal defect (VSD) is an opening in the interventricular septum, causing a left-to-right shunt. Over time, large left-to-right shunts cause pulmonary artery hypertension, elevated pulmonary artery vascular resistance, right ventricular pressure overload, and right ventricular hypertrophy and ultimately cause shunt direction to reverse, leading to Eisenmenger syndrome. Larger defects cause symptoms of heart failure by age 4 to 6 weeks. Typically, a grade 3 to 4/6 holosystolic murmur at the lower left sternal border is audible shortly after birth. Infants who do not respond to medical treatment of heart failure or have poor growth should have surgical repair during the first few months of life; even asymptomatic children with large VSDs should have repair during the first year of life. 