Ventricular septal defect natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Keri Shafer, M.D. [2]; Atif Mohammad, M.D., Priyamvada Singh, MBBS

Natural History

Natural history of unoperated ventricular septal defect. Muscular and membranous defects usually close spontaneously

Restrictive ventricular septal defect

Small shunt (Qρ/Qѕ < 1.5/1.0 Qρ/Qs is pressure gradient between pulmonary and systemic circulation)
No significant hemodynamic compromise

Moderately restrictive ventricular septal defect

Moderate shunt (Qρ/Qѕ=1.5-2.5/1.0)
Hemodynamic burden on left atrium and ventricle.
Increase in pulmonary vascular resistance
Atrial and ventricular arrhythmia can occur

Large or Non restrictive venticular defect

High left and right ventricular volume overload
High pulmonary vascular resistance
Eisenmenger syndrome

Complications

Endocarditis
Aortic regurgitation
Subaortic or subpulmonary stenosis
Eisenmenger syndrome
Atrial and ventricular arrhythmia can occur

Prognosis

Many small defects will close on their own. For those defects that do not spontaneously close, the outcome is good with surgical repair. Complications may result if a large defect is not treated.

References

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