Interventricular septal defect: what it is, causes, symptoms, diagnosis, and treatment

By Cristiano Antonino On Feb 25, 2023

Interventricular septal defect, is an opening in the interventricular septum that will cause communication between the ventricles

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When the defects are large, there will be a left-right shunt causing dyspnea; there will be the presence of a murmur located at the left lower margin.

Respiratory infections and heart failure may occur.

During childhood the defects may close spontaneously but surgery may be necessary.

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Interventricular septal defect will see pulmonary flow and atrial and left ventricular volume increase

Most interventricular septal defects will classify according to their location: there is periembranous, trabecular muscle, subpulmonary outlet (supracristal, conseptal, subarterial doubly connected), inlet (atrioventricular septal type, atrioventricular canal type).

Permembranous defects will involve the membranous septum near the tricuspid valve and may extend into the surrounding muscle tissue; this defect occurs just below the aortic valve.

Trabecular muscle defects can occur anywhere in the septum and will be surrounded by muscle tissue.

Subpulmonary septal defects will be in the ventricular septum but immediately below the pulmonary valve; these defects will be supracristal, conseptal, or subarterial doubly connected, will often be associated with aortic leaflet prolapse, and will result in aortic insufficiency.

Entry duct abnormalities will be bounded by the tricuspidal annulus and located posterior to the membranous septum; these will be named atrioventricular septal defects.

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Interventricular septal defects in misalignment will see displacement of the conal septum or ventricular outlet

If the conal septum is misaligned anteriorly, it will protrude into the right ventricular outflow tract with obstruction.

On the other hand, when it will be misaligned posteriorly, there may be obstruction in the left ventricular outflow tract.

The shunt, will vary depending on the size of the defect and pulmonary outflow tract obstruction and pulmonary vascular resistance.

In nonrestrictive interventricular septal defects, blood flow will pass from the wider defects; the pressure created between the two ventricles will give rise to a single shunt.

If there is no pulmonary stenosis, the shunt will cause pulmonary arterial hypertension, elevated pulmonary artery vascular resistance, ventricular pressure overload, and right ventricular hypertrophy.

Increased pulmonary vascular resistance will lead to reversal of the direction of the shunt, thus from the right to the left ventricle.

Restrictive defects of the interventricular septum, will be minor defects, blood flow and pressure transmission to the right ventricle will be limited.

These minor defects will see the presence of a small shunt, in this case, heart failure will not develop.

Symptoms, will vary depending on the size and amplitude of the shunt.

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If you will have a small interventricular septal defect in children, they will be asymptomatic

If the defect is larger, symptoms will appear as early as around the first month of life, and respiratory tract infections may also occur.

For diagnosis, the following will be used: chest radiography and echocardiography.

If the ventricular septal defect is large, chest X-ray shows cardiomegaly and accentuation of the pulmonary vascular pattern; ECG shows right ventricular hypertrophy or combined ventricular hypertrophy and occasionally left atrial dilatation; ECG and chest X-ray are typically normal if the ventricular septal defect is mild.

In two-dimensional echocardiography with flow study and colordoppler will establish the diagnosis by providing detailed anatomic and hemodynamic information, including location, defect size, and right ventricular pressure. Cardiac catheterization is rarely necessary for diagnosis.

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For small interventricular septal defects, it will not be necessary to resort to treatment, because they will tend to close spontaneously.

If they do not close, medical or surgical treatment will still not be necessary.

For pharmacological treatments, diuretics and ace inhibitors will be used to keep heart failure symptoms under control before undergoing surgery; in infants, they may come in handy if the size of the septum is moderate and will serve in waiting for it to close spontaneously.

If there is no response from infants, surgery may be necessary.

In asymptomatic children, ventricular septal defects will need to be repaired within the first year of life to prevent complications from arising.

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