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Ventricular Septal Defect (VSD) is a congenital cardiac anomaly characterized by a communication between the right and left ventricles due to an opening in the interventricular septum.
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It is the most common congenital heart defect, particularly in infants and children, accounting for ~20% of all CHDs.
The commonest heart defect ("Hole in the heart"). When small, such defects cause little in the way of problems and often "heal" (close) on their own. Blood flows from left ventricle to right ventricle at high pressure, often producing a loud "murmur" with each heart beat. The effect on heart function depends on the size of the defect, but may be very minor. Surgery may not be required, if the heart shows no evidence of "strain".
Cardiology : Ventricular Septal Defect VSD. Rch.org.au. Published 2025. Accessed July 11, 2025. https://www.rch.org.au/cardiology/heart_defects/Ventricular_Septal_Defect_VSD/
International Society for Nomenclature of Paediatric and Congenital Heart Disease classification:
VSDs can be classified in 4 types depending on the defect position and borders from the right ventricle (RV) perspective.
| Type | Frequency | Location |
|---|---|---|
| Central Perimembranous VSD | ~70–80% | Near tricuspid and aortic valves; most common |
| Trabecular muscular VSD | ~10–20% | In trabecular portion of septum; may be multiple (Swiss cheese VSD) |
| Outlet VSD | ~5–7%, common in Asians | Subdivisions: |
| • Outlet perimembranous defects: Involving the membranous part of the outlet septum | ||
| • Outlet muscular defects: Involving the muscular portion of the outlet septum | ||
| • Doubly committed juxta-arterial defects: Adjacent to both the aortic and pulmonary valves. | ||
| Inlet VSD | ~5% | Posterior septum near AV valves; associated with AVSD |
Diagram illustrating the anatomy of the right ventricle (A) and the classification of VSDs based on the margins and localization in the right ventricle (B).
Jacobs JP, Burke RP, Quintessenza JA et al. Congenital heart surgery nomenclature and database project: ventricular septal defect. Ann Thorac Surg. 2000; 69:S25–S35. Fusco F, Borrelli N, Palma M, Sarubbi B, Scognamiglio G. Imaging of ventricular septal defect: Native and post-repair. International Journal of Cardiology Congenital Heart Disease. 2022;7:100335-100335. doi:https://doi.org/10.1016/j.ijcchd.2022.100335
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Left-to-right shunt → increased pulmonary blood flow → volume overload of lungs and left heart
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| Small VSD | Large VSD |
|---|---|
| Asymptomatic or murmur only | Heart failure in infancy |
| Loud holosystolic murmur at LLSB | Poor feeding, tachypnea, FTT |
| Normal growth and development | Hepatomegaly, cardiomegaly |