Percentage of Congenital Heart Disease Attributed to PDA, ASD, and VSD
Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), and Patent Ductus Arteriosus (PDA) collectively account for approximately 37% of all congenital heart disease cases, with VSD being the most common at 24%, followed by PDA at 6.6% and ASD at 6.5%.
Breakdown by Individual Defect
Ventricular Septal Defect (VSD)
- VSD is the most common congenital heart defect at birth, occurring in approximately 3.0-3.5 infants per 1000 live births 1
- VSDs represent approximately 24% of all congenital heart disease cases 2
- Perimembranous VSDs (Type 2) are the most common type, accounting for approximately 80% of all VSDs 1
- VSDs are also commonly found in association with more complex congenital heart defects (10% of cases) 2
Patent Ductus Arteriosus (PDA)
- PDA accounts for approximately 5-10% of all congenital heart disease in term infants 3
- In the specific population studies, PDA represented about 6.6% of all congenital heart defects 2
- The occurrence of PDA is inversely related to gestational age and weight, with higher incidence in preterm infants 3
Atrial Septal Defect (ASD)
- ASDs comprise approximately 6.5% of all congenital heart defects 2
- ASDs are less common than VSDs but remain one of the most frequent acyanotic congenital heart lesions 2
- ASDs are found as an association in approximately 1.2% of patients with more complex congenital heart disease 2
Clinical Significance and Complications
Risk of Infective Endocarditis (IE)
- Unrepaired VSDs carry a higher risk of infective endocarditis compared to surgically closed VSDs 4
- The presence of aortic regurgitation independently increases the risk of IE in patients with VSD, whether managed medically or surgically 4
- Of patients with surgically repaired VSDs who developed IE, at least 22% were known to have a residual VSD leak 4
- Interestingly, IE is rarely reported in isolated ASDs, closed VSDs without residual defects, isolated patent ductus, or isolated pulmonary stenosis 4
Genetic Associations
- Down syndrome is commonly associated with congenital heart defects, particularly VSDs and atrioventricular septal defects 4
- DiGeorge syndrome (22q11.2 deletion) is associated with various congenital heart defects including VSDs 4
- Klinefelter syndrome has a 50% association with CHD, particularly PDA and ASD 4
Management Considerations
Interventional Procedures
- Both ASD and PDA can be effectively managed with transcatheter closure procedures, which have high success rates (98-99%) 5
- Class III (suboptimal) procedural performance occurs in only about 2% of both ASD and PDA closure cases 5
- For PDA closures, younger age and lower weight are associated with higher risk of suboptimal outcomes 5
Surgical Management
- Most cases of VSDs and TOF (Tetralogy of Fallot) recommended for surgery belong to risk category 2 (28.1%) followed by risk category 1 (12.7%) of the RACHS-1 scoring system 2
- Early surgical correction of significant defects is recommended to prevent complications such as pulmonary vascular disease 4
Common Pitfalls and Caveats
- Not all heart murmurs in children indicate congenital heart disease - approximately 25% of referrals for suspected CHD have normal hearts 2
- The risk of developing pulmonary arterial hypertension varies by defect size - small VSDs (<1 cm) have only a 3% risk, while larger defects (>1.5 cm) carry a 50% risk 4
- For patients with atrial septal defects, those with sinus venosus defects have a higher incidence of pulmonary arterial hypertension (16%) compared to ostium secundum defects (4%) 4
- Muscular VSDs (Type 4) often have a high rate of spontaneous closure, which may affect their representation in older populations 1