From the Guidelines
The most common congenital cardiac defect is ventricular septal defect (VSD), option (b). VSDs account for approximately 3.0 to 3.5 infants per 1000 live births, as stated in the acc/aha 2008 guidelines for the management of adults with congenital heart disease 1.
Key Characteristics of VSD
- VSD is an abnormal opening in the wall (septum) that separates the two lower chambers (ventricles) of the heart, allowing blood to flow directly from the left ventricle to the right ventricle.
- There are 4 anatomic types of VSDs, with type 2 or perimembranous VSDs being the most common, accounting for almost 80% of defects 1.
- The clinical significance of VSD varies depending on the size of the defect, with small VSDs often closing spontaneously during early childhood.
- Larger defects may cause significant left-to-right shunting, leading to pulmonary overcirculation, heart failure symptoms, and if left untreated, potential pulmonary hypertension.
Management of VSD
- Management ranges from watchful waiting for small defects to surgical or catheter-based closure for larger, symptomatic defects.
- Early detection through physical examination (characteristic murmur) and confirmation with echocardiography are essential for appropriate management, as noted in the guidelines 1. Some key points to consider when managing VSD include:
- Spontaneous closure of small VSDs is common, especially in type 4 or muscular VSDs.
- Type 1 VSDs lie in the outflow portion of the RV and account for approximately 6% of defects in non-Asian populations but up to 33% in Asian patients 1.
- Type 3 or inlet VSDs occur in the lower part of the right ventricle and adjacent to the tricuspid valve, typically in patients with Down syndrome 1.
From the Research
Congenital Cardiac Defects
- The most common congenital cardiac defect is the ventricular septal defect (VSD) 2, 3, 4.
- VSDs are a communication between the left and right ventricles, allowing blood to flow from one side to the other 4.
- They can vary in location, size, and clinical presentation, and may be associated with other cardiac defects 2, 5.
Prevalence of VSD
- VSDs are found in approximately 68% of cases of aortic coarctation, 62% of heterotaxy syndromes, and 54% of transposition of the great arteries 5.
- They are also commonly associated with tetralogy of Fallot, double inlet left ventricle, and congenitally corrected transposition of the great arteries 5.
Comparison with Other Defects
- Atrial septal defects (ASDs) are less common than VSDs, but may be associated with similar clinical presentations 6.
- Transposition of the great arteries (TGA) is a cyanotic congenital heart defect that may be associated with VSDs or ASDs 6.
- Aortic coarctation is a narrowing of the aortic isthmus that may be associated with VSDs or other cardiac defects 5.