Ventricular septal defect (VSD) is the most common congenital heart defect, accounting for approximately 25% of cases. The majority (80%) of VSDs are located in the perimembranous region of the septum. A left-to-right shunt created by the VSD can lead to irreversible changes in the pulmonary vasculature and pulmonary hypertension if not repaired. Surgical closure of VSDs reduces the risk of endocarditis and has a mortality rate of around 1% without pulmonary hypertension. However, VSD repair is contraindicated if pulmonary hypertension is irreversible due to high risks of complications.

1. Ventricular septal defect
In the good cause of patient interest

2. • VSD was classified based on
outlet, membranous,inlet,
atrioventricular canal, and
muscular types.
• VSD was also classified according
to size. The VSD size was
considered small (diameter 3
mm), moderate (3–6 mm), or
large (>6 mm).

3. Epidemiology
• Ventricular septal defect (VSD) is the most common congenital heart defect
• accounting for approximately 25% of congenital heart defects
• The incidence of VSD is 1.56 to 53.2 per 1000 live births
• congenital heart defects are found in 0.3 per 1000 in the general
Population
• Approximately 80% of all VSD are perimembranous
• 8% of these are the inlet type
• 5%–20% are the muscular form
• only 6% being the outlet type

4. pathophysiology
• The shunt created between the right and left ventricles is the most
common pathophysiologic mechanism of VSD which determines
hemodynamic significance
• With a long-standing large left-to-right shunt, the pulmonary vascular
endothelium undergoes irreversible changes resulting in persistent
pulmonary hypertension (PH).
• When the pressure in the pulmonary circulation exceeds the
pressure in the systemic circulation, the shunt direction reverses and
becomes a right-to-left shunt. This is known as Eisenmenger
syndrome and it occurs in 10% to 15% of patients
• with VSD

5. Surgical VSD closure
• Surgical VSD closure reduces the endocarditis risk
• without PH, the operative mortality rate is approximately 1%
• The main contraindication for surgical VSD closure is irreversible PH due to
the associated high perioperative mortality and pulmonary complications
• Young children who remain asymptomatic and have a small VSD have a
good outcome
• anemia, infection, or endocarditis may trigger symptoms in these children
• The outcome in children with a large VSD is poor if the defect is not
repaired
•

6. Ganesha Puja- 2019