8th March 2024

Clinical presentation

Most patients with a small VSD will remain asymptomatic and the natural history will depend on the location and size of the defect as these impact the degree of left-to-right shunting.

On auscultation of the heart, a small VSD will produce a holosystolic murmur at the left parasternal border and a palpable systolic thrill. A moderate sized VSD may elicit a mitral diastolic rumble and S3 gallop due to LA and LV dilatation with increased flow across the mitral valve. Large VSD can progress to pulmonary hypertension and Eisenmenger syndrome. Signs of pulmonary hypertension, such as a left parasternal heave and loud P2, may be present. Other findings in large VSD include S4 heart sound, tricuspid regurgitation and Graham Steele murmur. 

Complications of VSD include:

• Left heart failure 
• Pulmonary hypertension (Cor pulmonale due to pressure and volume overload) 
• Tricuspid regurgitation
• Arrhythmias 
• Infective endocarditis 
• Aortic regurgitation due to leaflet prolapse 
• Subaortic stenosis 
• Double-chambered right ventricle where a muscle band develops as a result of VSD jet leading to infundibular pulmonary stenosis.