Ventricular septal defect

Abstract

BackgroundVentricular septal defects are the commonest congenital cardiac malformations. They can exist in isolation, but are also found as integral components of other cardiac anomalies, such as tetralogy of Fallot, double outlet right ventricle, or common arterial trunk. As yet, there is no agreement on how best to classify such defects, nor even on the curved surface that is taken to represent the defect.MethodsBased on our previous pathological and clinical experiences, we have reviewed the history of classification of holes between the ventricles. We proposed that the defects are best defined as representing the area of deficient ventricular septation. This then permits the recognition of clinically significant variants according to the anatomic borders, and the way the curved surface representing the area of deficient septation opens into the morphologically right ventricle.ResultsClinical manifestation depends on the size of the defect, and on the relationship between systemic and pulmonary vascular resistances. Symptoms include failure to thrive, along with the manifestations of the increase in flow of blood to the lungs. Diagnosis can be made by physical examination, but is confirmed by echocardiographic interrogation, which delineates the precise anatomy, and also provides the physiologic information required for optimal clinical decision-making. Cardiac catheterization offers additional information regarding hemodynamics, particularly if there is a concern regarding an increase in pulmonary vascular resistance. Hemodynamic assessment is rarely necessary to make decisions regarding management, although it can be helpful if assessing symptomatic adults with hemodynamically restrictive defects. In infants with defects producing large shunts, surgical closure is now recommended in most instances as soon as symptoms manifest. Only in rare cases is palliative banding of the pulmonary trunk now recommended. Closure with devices inserted on catheters is now the preferred approach for many patients with muscular defects, often using a hybrid procedure. Therapeutic closure should now be anticipated with virtually zero mortality, and with excellent anticipated long-term survival.ConclusionVentricular septal defects are best defined as representing the borders of the area of deficient ventricular septation. An approach on this basis permits recognition of the clinically significant phenotypic variants.

Anatomy of the ventricular septal defect in congenital heart defects: a random association?

“…The other one is based on the borders of the defect, namely the existence or not of a fibrous component at the postero-inferior part of the defect. This is important for the surgeon because of the risk of injury of the conduction tissue if such a fibrous component exists [ 9 ]. The differences between these two approaches still induce confusion in the classification and nomenclature of the VSDs.…”

Spatio‐temporal image correlation rendering mode visualizes the specific location and surrounding structure of ventricular septal defect

“…VSD refers to the ventricular septal dysplasia during the embryonic period, leading to an abnormal communication between the left and right ventricles. VSD can exist isolatedly, and can be complicated by other cardiac anomalies, such as tetralogy of Fallot, double outlet right ventricle, or transposition (Spicer et al, ). In this study, we focused on the isolated defects.…”

A new anatomic approach of the ventricular septal defect in the interruption of the aortic arch

“…This channel between the ventricles can also be described as an interventricular communication, especially in the setting of DORV, in which the hole that will be closed by the surgeon is not a hole within the ventricular septum itself and thus a plane surface, but a curved surface between malaligned septal structures which are normally aligned in the normal heart (Spicer et al. ). However, in this study we use the term ‘VSD’ to describe any type of channel between the ventricles.…”