Skip to content

Ventricular Septal Defect


Share on facebook
Share on twitter
Share on linkedin
Share on whatsapp

Definition: interventricular septal communication (IVS) defined by its location. The IVS can be divided into a muscular and membranous portion, hence perimembranous VSD (80%) or muscular VSD (inlet/trabecular/outlet = infundibular region).  It is the most common type of CHD.

Incidence: 1.7-53:1000 of all live births.

Prevalence: 20% as a single lesion, 50% as part of lesion in CHD.


Depends on the size, PVR, RVP and LVP

  • in neonates with increased PVR there is minimal shunting
  • where there is a drop in PVR and and therefore less restrictive, there is a left to right shunt leading to volume load in the LA and LV.  This can lead to CCF and, if long standing, Eisenmenger syndrome


  • Clinical examination: auscultation – holosystolic murmur; cyanosis; and clubbing in Eisenmenger syndrome
  • ECG: LVH
  • CXR: increased pulmonary blood blow (in Eisenmenger there is reduced PBF)
  • ECHO: for size, location, shunt, haemodynamic evaluation
  • MRI: limited usefulness
  • Cardiac catheterization: PVR, response to pulmonary vasodilators, Qp:Qs

Preoperative management:

Treat CCF: CPAP/IPPV if required; digoxin; frusemide (1mg/kg up to QID); spironolactone (1mg/kg BD).

Aim for an afterload reduction:milrinone (0.25-0.5 mcg/kg/min) or captopril (0.1-2 mg/kg TDS).

Preoperative preparation:

ECG, CXR, CUS, FBE, clotting, UEC, PRBC (4), FFP (2), platelets (2), cryoprecipitate (2). methylprednisolone 10mg/kg 12hrs and 6hrs pre surgery in neonates.


Pulmonary artery banding for protection of pulmonary circulation in neonates with multiple VSDs and CCF

In children >3 months (Qp:Qs >1.5:1), surgical closure via transatrial approach, sometimes by right ventriculotomy, and rarely by left apical ventriculotomy. Catheter closure by amplatzer device. Heart-lung transplantation in Eisenmenger syndrome.

Postoperative management:

  • Inotropes: milrinone plus dopamine or adrenaline (plus noradrenaline). Aim for MAP >40 mmHg in neonates.
  • Haemodynamics: age adjusted (in neonates: SBP >60 mmHg, MAP >40 mmHg, CVP 8-12 mmHg).
  • Respiratory: normoxaemia, normocapnea.
  • Fluid restriction: 1ml/kg/hr, early feeds.
  • Continue preoperative diuretic therapy.
  • Haemostasis.
  • If catheter closure: aspirin 5mg/kg OD once feeds tolerated.

Specific problems:


Average ICU stay: 2 days.

Mortality: <1% in isolated VSD, but up 5-10% in multiple defects.

Residual shunts: 30% after surgical closure, majority close spontaneously.


[1] Br Heart J. 1980 Mar;43(3):332-43: Soto et al: Classification of ventricular septal defects

[2] Circulation. 2006 Nov 14;114(20):2190-7: Minette et al: Ventricular septal defects

[3] Cardiol Young. 2007 Jun;17(3):243-53: Butera et al: Percutaneous closure of ventricular septal defects

 All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or AndroidA list of contributors can be seen here.

About the authors


High flow therapy – when and how?

Chest compressions in traumatic cardiac arrest

Searching for sepsis

The missing link? Children and transmission of SARS-CoV-2

Don’t Forget the Brain Busters – Round 2

An evidence summary of Paediatric COVID-19 literature


The fidget spinner craze – the good, the bad and the ugly

Parenteral Nutrition

Leave a Reply

Your email address will not be published.



We use cookies to give you the best online experience and enable us to deliver the DFTB content you want to see. For more information, read our full privacy policy here.