Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Management of isolated ventricular septal defects in infants and children

David R Fulton, MD
Susan Saleeb, MD
Section Editor
John K Triedman, MD
Deputy Editor
Carrie Armsby, MD, MPH


Ventricular septal defect (VSD) is one of the most common congenital heart defects, occurring in almost 50 percent of all patients with congenital heart disease (CHD). VSDs occur in isolation or in combination with other CHD defects, as in an atrioventricular (AV) canal, tetralogy of Fallot (TOF), and, occasionally, D-transposition of the great arteries (D-TGA).

The management of infants and children with isolated VSDs will be discussed here. The pathophysiology, natural history, clinical manifestations, and diagnosis of isolated VSDs are discussed separately. (See "Pathophysiology and clinical features of isolated ventricular septal defects in infants and children" and "Echocardiographic evaluation of ventricular septal defects".)

The management of complex CHD that includes VSD is discussed separately:

AV canal defects (see "Management and outcome of atrioventricular (AV) canal defects")

TOF (see "Management and outcome of tetralogy of Fallot")


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 25, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Rudolph AM. Ventricular Septal Defect. In: Congenital Diseases of the Heart: Clinical-Physiological Considerations, Rudolph AM (Ed), Futura Publishing Company, New York 2001. p.197.
  2. Kleinman CS, Tabibian M, Starc TJ, et al. Spontaneous regression of left ventricular dilation in children with restrictive ventricular septal defects. J Pediatr 2007; 150:583.
  3. Neumayer U, Stone S, Somerville J. Small ventricular septal defects in adults. Eur Heart J 1998; 19:1573.
  4. Gumbiner CH, Takao A. Ventricular septal defect. In: The Science and Practice of Pediatric Cardiology, 2nd ed, Garson A, Bricker JT, Fisher DJ, Neish SR (Eds), Williams & Wilkins, Baltimore 1998. p.1119.
  5. Montigny M, Davignon A, Fouron JC, et al. Captopril in infants for congestive heart failure secondary to a large ventricular left-to-right shunt. Am J Cardiol 1989; 63:631.
  6. Berman W Jr, Ravenscroft PJ, Sheiner LB, et al. Differential effects of digoxin at comparable concentrations in tissues of fetal and adult sheep. Circ Res 1977; 41:635.
  7. Berman W Jr, Yabek SM, Dillon T, et al. Effects of digoxin in infants with congested circulatory state due to a ventricular septal defect. N Engl J Med 1983; 308:363.
  8. Kimball TR, Daniels SR, Meyer RA, et al. Effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect. Am J Cardiol 1991; 68:1377.
  9. Backer CL, Winters RC, Zales VR, et al. Restrictive ventricular septal defect: how small is too small to close? Ann Thorac Surg 1993; 56:1014.
  10. Fellows KE, Keane JF, Freed MD. Angled views in cineangiocardiography of congenital heart disease. Circulation 1977; 56:485.
  11. Hitchcock JF, Suijker WJ, Ksiezycka E, et al. Management of ventricular septal defect with associated aortic incompetence. Ann Thorac Surg 1991; 52:70.
  12. Ishikawa S, Morishita Y, Sato Y, et al. Frequency and operative correction of aortic insufficiency associated with ventricular septal defect. Ann Thorac Surg 1994; 57:996.
  13. Rhodes LA, Keane JF, Keane JP, et al. Long follow-up (to 43 years) of ventricular septal defect with audible aortic regurgitation. Am J Cardiol 1990; 66:340.
  14. Backer CL, Idriss FS, Zales VR, et al. Surgical management of the conal (supracristal) ventricular septal defect. J Thorac Cardiovasc Surg 1991; 102:288.
  15. Bol-Raap G, Weerheim J, Kappetein AP, et al. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003; 24:511.
  16. Weintraub RG, Menahem S. Early surgical closure of a large ventricular septal defect: influence on long-term growth. J Am Coll Cardiol 1991; 18:552.
  17. Kidd L, Driscoll DJ, Gersony WM, et al. Second natural history study of congenital heart defects. Results of treatment of patients with ventricular septal defects. Circulation 1993; 87:I38.
  18. Moller JH, Patton C, Varco RL, Lillehei CW. Late results (30 to 35 years) after operative closure of isolated ventricular septal defect from 1954 to 1960. Am J Cardiol 1991; 68:1491.
  19. Meijboom F, Szatmari A, Utens E, et al. Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 1994; 24:1358.
  20. Lincoln C, Jamieson S, Joseph M, et al. Transatrial repair of ventricular septal defects with reference to their anatomic classification. J Thorac Cardiovasc Surg 1977; 74:183.
  21. Karadeniz C, Atalay S, Demir F, et al. Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure? Pediatr Cardiol 2015; 36:481.
  22. Lock JE, Block PC, McKay RG, et al. Transcatheter closure of ventricular septal defects. Circulation 1988; 78:361.
  23. Knauth AL, Lock JE, Perry SB, et al. Transcatheter device closure of congenital and postoperative residual ventricular septal defects. Circulation 2004; 110:501.
  24. Butera G, Carminati M, Chessa M, et al. Transcatheter closure of perimembranous ventricular septal defects: early and long-term results. J Am Coll Cardiol 2007; 50:1189.
  25. Kanaan M, Ewert P, Berger F, et al. Follow-up of patients with interventional closure of ventricular septal defects with Amplatzer Duct Occluder II. Pediatr Cardiol 2015; 36:379.
  26. Landman G, Kipps A, Moore P, et al. Outcomes of a modified approach to transcatheter closure of perimembranous ventricular septal defects. Catheter Cardiovasc Interv 2013; 82:143.
  27. Thanopoulos BD, Rigby ML. Outcome of transcatheter closure of muscular ventricular septal defects with the Amplatzer ventricular septal defect occluder. Heart 2005; 91:513.
  28. Van Hare GF, Ackerman MJ, Evangelista JA, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 4: Congenital Heart Disease: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e281.
  29. Tennant PW, Pearce MS, Bythell M, Rankin J. 20-year survival of children born with congenital anomalies: a population-based study. Lancet 2010; 375:649.
  30. Jortveit J, Leirgul E, Eskedal L, et al. Mortality and complications in 3495 children with isolated ventricular septal defects. Arch Dis Child 2016; 101:808.
  31. Danilowicz D, Presti S, Colvin S, et al. Results of urgent or emergency repair for symptomatic infants under one year of age with single or multiple ventricular septal defect. Am J Cardiol 1992; 69:699.
  32. Van Hare GF, Soffer LJ, Sivakoff MC, Liebman J. Twenty-five-year experience with ventricular septal defect in infants and children. Am Heart J 1987; 114:606.
  33. Gersony WM, Hayes CJ, Driscoll DJ, et al. Second natural history study of congenital heart defects. Quality of life of patients with aortic stenosis, pulmonary stenosis, or ventricular septal defect. Circulation 1993; 87:I52.
  34. McNamara DG, Latson LA. Long-term follow-up of patients with malformations for which definitive surgical repair has been available for 25 years or more. Am J Cardiol 1982; 50:560.
  35. Scully BB, Morales DL, Zafar F, et al. Current expectations for surgical repair of isolated ventricular septal defects. Ann Thorac Surg 2010; 89:544.
  36. Carminati M, Butera G, Chessa M, et al. Transcatheter closure of congenital ventricular septal defects: results of the European Registry. Eur Heart J 2007; 28:2361.
  37. Butera G, Chessa M, Carminati M. Percutaneous closure of ventricular septal defects. Cardiol Young 2007; 17:243.
  38. Gabriel HM, Heger M, Innerhofer P, et al. Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol 2002; 39:1066.