Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Echocardiographic evaluation of ventricular septal defects

Ann Kavanaugh-McHugh, MD
Section Editor
Warren J Manning, MD
Deputy Editor
Brian C Downey, MD, FACC


A ventricular septal defect (VSD) is one of the most common congenital cardiac abnormalities in the newborn, but it is less common in the adult due to spontaneous closure of most muscular VSDs during early growth. It can occur as an isolated finding or in combination with other congenital defects. VSD can also be an acquired disorder, occurring after acute myocardial infarction or chest wall trauma. (See "Mechanical complications of acute myocardial infarction".)

The echocardiographic evaluation of VSD will be reviewed here. Alternative imaging modalities for assessing VSDs, as well as the pathophysiology and clinical features of this defect, are discussed separately. (See "Clinical utility of cardiovascular magnetic resonance imaging", section on 'Congenital heart disease' and "Pathophysiology and clinical features of isolated ventricular septal defects in infants and children".)


Echocardiography is valuable not only in diagnosing VSDs but also in the percutaneous and surgical treatment of these defects [1]. Echocardiographic evaluation of VSDs includes:

Identification of the location of defects on the septum

Establishing the number of defects

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Oct 07, 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 ©2017 UpToDate, Inc.
  1. Penny DJ, Vick GW 3rd. Ventricular septal defect. Lancet 2011; 377:1103.
  2. Kardon RE, Cao QL, Masani N, et al. New insights and observations in three-dimensional echocardiographic visualization of ventricular septal defects: experimental and clinical studies. Circulation 1998; 98:1307.
  3. van den Bosch AE, Ten Harkel DJ, McGhie JS, et al. Feasibility and accuracy of real-time 3-dimensional echocardiographic assessment of ventricular septal defects. J Am Soc Echocardiogr 2006; 19:7.
  4. Cossor W, Cui VW, Roberson DA. Three-Dimensional Echocardiographic En Face Views of Ventricular Septal Defects: Feasibility, Accuracy, Imaging Protocols and Reference Image Collection. J Am Soc Echocardiogr 2015; 28:1020.
  5. Cheng TO, Xie MX, Wang XF, et al. Real-time 3-dimensional echocardiography in assessing atrial and ventricular septal defects: an echocardiographic-surgical correlative study. Am Heart J 2004; 148:1091.
  6. Mercer-Rosa L, Seliem MA, Fedec A, et al. Illustration of the additional value of real-time 3-dimensional echocardiography to conventional transthoracic and transesophageal 2-dimensional echocardiography in imaging muscular ventricular septal defects: does this have any impact on individual patient treatment? J Am Soc Echocardiogr 2006; 19:1511.
  7. Hadeed K, Hascoet S, Amadieu R, et al. Assessment of Ventricular Septal Defect Size and Morphology by Three-Dimensional Transthoracic Echocardiography. J Am Soc Echocardiogr 2016; 29:777.
  8. Michel-Behnke I, Ewert P, Koch A, et al. Device closure of ventricular septal defects by hybrid procedures: a multicenter retrospective study. Catheter Cardiovasc Interv 2011; 77:242.
  9. Mo X, Zuo W, Ma Z, et al. Hybrid procedure with cardiopulmonary bypass for muscular ventricular septal defects in children. Eur J Cardiothorac Surg 2011; 40:1203.
  10. Yang J, Yang L, Wan Y, et al. Transcatheter device closure of perimembranous ventricular septal defects: mid-term outcomes. Eur Heart J 2010; 31:2238.
  11. Miyake T, Shinohara T, Nakamura Y, et al. Aneurysm of the ventricular membranous septum: serial echocardiographic studies. Pediatr Cardiol 2004; 25:385.
  12. Eroğlu AG, Oztunç F, Saltik L, et al. Evolution of ventricular septal defect with special reference to spontaneous closure rate, subaortic ridge and aortic valve prolapse. Pediatr Cardiol 2003; 24:31.
  13. Silverman NH. Pediatric Echocardiography, Williams & Wilkins, Baltimore 1993. p.123.
  14. Snider AR, Serwer GA, Ritter SB. in Pediatric Heart Disease, Mosby, St Louis 1997. p.265.
  15. Lun K, Li H, Leung MP, et al. Analysis of indications for surgical closure of subarterial ventricular septal defect without associated aortic cusp prolapse and aortic regurgitation. Am J Cardiol 2001; 87:1266.
  16. Graham, TP, Kavanaugh-McHugh, A . Ventricular septal defect and aortic regurgitation. Prog Pediatr Cardiol 2001; 14:163.
  17. Tomita H, Arakaki Y, Ono Y, et al. Impact of noncoronary cusp prolapse in addition to right coronary cusp prolapse in patients with a perimembranous ventricular septal defect. Int J Cardiol 2005; 101:279.
  18. Tomita H, Arakaki Y, Ono Y, et al. Severity indices of right coronary cusp prolapse and aortic regurgitation complicating ventricular septal defect in the outlet septum: which defect should be closed? Circ J 2004; 68:139.
  19. Sommer RJ, Golinko RJ, Ritter SB. Intracardiac shunting in children with ventricular septal defect: evaluation with Doppler color flow mapping. J Am Coll Cardiol 1990; 16:1437.
  20. Stojnić B, Pavlović P, Ponomarev D, et al. Bidirectional shunt flow across a ventricular septal defect: pulsed Doppler echocardiographic analysis. Pediatr Cardiol 1995; 16:6.
  21. Goldberg SJ, Allen HD, Marx GR, et al. Clinical application of Doppler Echocardiography to flow measurements. In: Doppler Echocardiography, Lea & Febiger, Philadelphia 1985. p.92.
  22. Sanders SP, Yeager S, Williams RG. Measurement of systemic and pulmonary blood flow and QP/QS ratio using Doppler and two-dimensional echocardiography. Am J Cardiol 1983; 51:952.
  23. Vargas Barron J, Sahn DJ, Valdes-Cruz LM, et al. Clinical utility of two-dimensional doppler echocardiographic techniques for estimating pulmonary to systemic blood flow ratios in children with left to right shunting atrial septal defect, ventricular septal defect or patent ductus arteriosus. J Am Coll Cardiol 1984; 3:169.
  24. Cloez JL, Schmidt KG, Birk E, Silverman NH. Determination of pulmonary to systemic blood flow ratio in children by a simplified Doppler echocardiographic method. J Am Coll Cardiol 1988; 11:825.
  25. Meijboom EJ, Horowitz S, Valdes-Cruz LM, et al. A simplified mitral valve method for two-dimensional echo Doppler blood flow calculation: validation in an open-chest canine model and initial clinical studies. Am Heart J 1987; 113:335.
  26. Sabry AF, Reller MD, Silberbach GM, et al. Comparison of four Doppler echocardiographic methods for calculating pulmonary-to-systemic shunt flow ratios in patients with ventricular septal defect. Am J Cardiol 1995; 75:611.
  27. Moises VA, Maciel BC, Hornberger LK, et al. A new method for noninvasive estimation of ventricular septal defect shunt flow by Doppler color flow mapping: imaging of the laminar flow convergence region on the left septal surface. J Am Coll Cardiol 1991; 18:824.
  28. Karr SS. New Doppler techniques for the evaluation of regurgitant and shunt volumes. Curr Opin Cardiol 1998; 13:56.
  29. Kurotobi S, Sano T, Matsushita T, et al. Quantitative, non-invasive assessment of ventricular septal defect shunt flow by measuring proximal isovelocity surface area on colour Doppler mapping. Heart 1997; 78:305.
  30. Ishii M, Hashino K, Eto G, et al. Quantitative assessment of severity of ventricular septal defect by three-dimensional reconstruction of color Doppler-imaged vena contracta and flow convergence region. Circulation 2001; 103:664.
  31. Oyamada J, Toyono M, Shimada S, et al. Noninvasive estimation of left ventricular end-diastolic pressure using tissue Doppler imaging combined with pulsed-wave Doppler echocardiography in patients with ventricular septal defects: a comparison with the plasma levels of the B-type natriuretic Peptide. Echocardiography 2008; 25:270.
  32. Hatle I, Angelson B. Doppler ultrasound in cardiology. Physical principles and clinical applications, 2nd ed, Lea and Febiger, Philadelphia 1985. p.236.
  33. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984; 70:657.
  34. Masuyama T, Kodama K, Kitabatake A, et al. Continuous-wave Doppler echocardiographic detection of pulmonary regurgitation and its application to noninvasive estimation of pulmonary artery pressure. Circulation 1986; 74:484.
  35. Lee RT, Lord CP, Plappert T, Sutton MS. Prospective Doppler echocardiographic evaluation of pulmonary artery diastolic pressure in the medical intensive care unit. Am J Cardiol 1989; 64:1366.
  36. Schamberger MS, Farrell AG, Darragh RK, et al. Use of peak Doppler gradient across ventricular septal defects leads to underestimation of right-sided pressures in patients with "sloped" Doppler signals. J Am Soc Echocardiogr 2001; 14:1197.
  37. Lindblade CL, Schamberger MS, Darragh RK, Cordes TM. Use of peak Doppler gradient across ventricular septal defect leads to underestimation of right-sided pressures in a patient with M-shaped Doppler signal: a case report. J Am Soc Echocardiogr 2004; 17:1207.
Topic Outline