Ventricular Septal Defects Differential Diagnoses

  • Author: Prema Ramaswamy, MD; Chief Editor: Stuart Berger, MD   more...
 
Updated: Nov 1, 2011
 
 

Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis of ventricular septal defect (VSD), other problems to be considered include the following:

  • VSD with associated defects
  • Atrioventricular (AV) septal defect
  • Double-outlet right ventricle (RV) with normally related great arteries
  • Mild or moderate subaortic stenosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Prema Ramaswamy, MD  Associate Professor of Clinical Pediatrics, State University of New York Downstate; Adjunct Assistant Clinical Professor of Pediatrics, St George's University School of Medicine; Co-Director of Pediatric Cardiology, Maimonides Medical Center, Lutheran Medical Center, and Coney Island Hospital

Prema Ramaswamy, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Kuruchi Srinivasan, MD  Consulting Staff, Department of Internal Medicine, Nazareth Hospital

Kuruchi Srinivasan, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Patturajah Anbumani, MD, MBBS, MS, MCh Associate Medical Director, Best Medical Care; Former Associate Medical Director, Jeanes Hospital, Temple University Health System; Former Adjunct Clinical Assistant Professor, New York College of Osteopathic Medicine; Former Clinical Assistant Professor, Department of Medicine, State University of New York-Downstate

Patturajah Anbumani, MD, MBBS, MS, MCh is a member of the following medical societies: American College of Physicians, American Medical Association, and American Medical Women's Association

Disclosure: Nothing to disclose.

Hugh D Allen, MD Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Viswanath Natesan, MD Staff Physician, Department of Internal Medicine, Lutheran Medical Center

Disclosure: Nothing to disclose.

Ashmitha Srinivasan Drexel University College of Medicine

Disclosure: Nothing to disclose.

Sharmila Srinivasan State University of New York Upstate Medical University

Disclosure: Nothing to disclose.

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research,Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Additional Contributors

Patturajah Anbumani, MD, MBBS, MS, MCh Associate Medical Director, Best Medical Care; Former Associate Medical Director, Jeanes Hospital, Temple University Health System; Former Adjunct Clinical Assistant Professor, New York College of Osteopathic Medicine; Former Clinical Assistant Professor, Department of Medicine, State University of New York-Downstate

Patturajah Anbumani, MD, MBBS, MS, MCh is a member of the following medical societies: American College of Physicians, American Medical Association, and American Medical Women's Association

Disclosure: Nothing to disclose.

Hugh D Allen, MD Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Viswanath Natesan, MD Staff Physician, Department of Internal Medicine, Lutheran Medical Center

Disclosure: Nothing to disclose.

Ashmitha Srinivasan Drexel University College of Medicine

Disclosure: Nothing to disclose.

Sharmila Srinivasan State University of New York Upstate Medical University

Disclosure: Nothing to disclose.

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research,Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Roger H. Clinical researches on the congenital communication of the two sides of the heart by failure of occlusion of the interventricular septum. Bull de l' Acad de Med. 1879;8:1074.

  2. Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J. Sep 27 1958;755-62. [Medline].

  3. Heath D, Edwards JE. The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation. Oct 1958;18(4 Part 1):533-47. [Medline].

  4. Van Praagh R, Geva T, Kreutzer J. Ventricular septal defects: how shall we describe, name and classify them?. J Am Coll Cardiol. Nov 1 1989;14(5):1298-9. [Medline].

  5. 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. Feb 1993;87(2 Suppl):I38-51. [Medline].

  6. Wu MH, Wu JM, Chang CI, et al. Implication of aneurysmal transformation in isolated perimembranous ventricular septal defect. Am J Cardiol. Sep 1 1993;72(7):596-601. [Medline].

  7. Wu MH, Wang JK, Lin MT, et al. Ventricular septal defect with secondary left ventricular-to-right atrial shunt is associated with a higher risk for infective endocarditis and a lower late chance of closure. Pediatrics. Feb 2006;117(2):e262-7. [Medline].

  8. Rubin JD, Ferencz C, Loffredo C. Use of prescription and non-prescription drugs in pregnancy. The Baltimore-Washington Infant Study Group. J Clin Epidemiol. Jun 1993;46(6):581-9. [Medline].

  9. Roguin N, Du ZD, Barak M, Nasser N, Hershkowitz S, Milgram E. High prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol. Nov 15 1995;26(6):1545-8. [Medline].

  10. Corone P, Doyon F, Gaudeau S, et al. Natural history of ventricular septal defect. A study involving 790 cases. Circulation. Jun 1977;55(6):908-15. [Medline].

  11. Pongiglione G, Freedom RM, Cook D, Rowe RD. Mechanism of acquired right ventricular outflow tract obstruction in patients with ventricular septal defect: an angiocardiographic study. Am J Cardiol. Oct 1982;50(4):776-80. [Medline].

  12. Zielinsky P, Rossi M, Haertel JC, et al. Subaortic fibrous ridge and ventricular septal defect: role of septal malalignment. Circulation. Jun 1987;75(6):1124-9. [Medline].

  13. Muller WH, Danimann JF. The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow; a preliminary report. Surg Gynecol Obstet. Aug 1952;95(2):213-9. [Medline].

  14. Lillehei CW, Cohen M, Warden HE. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surg Gynecol Obstet. Oct 1955;101(4):446-66. [Medline].

  15. Barratt-Boyes BG, Neutze JM, Clarkson PM, et al. Repair of ventricular septal defect in the first two years of life using profound hypothermia-circulatory arrest techniques. Ann Surg. Sep 1976;184(3):376-90. [Medline].

  16. Barratt-Boyes BG, Simpson M, Neutze JM, et al. Intracardiac surgery in neonates and infants using deep hypothermia with surface cooling and limited cardiopulmonary bypass. Circulation. May 1971;43(5 Suppl):I25-30. [Medline].

  17. Castaneda AR, Lamberti J, Sade RM, et al. Open-heart surgery during the first three months of life. J Thorac Cardiovasc Surg. Nov 1974;68(5):719-31. [Medline].

  18. Fu YC, Bass J, Amin Z, et al. Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: results of the U.S. phase I trial. J Am Coll Cardiol. Jan 17 2006;47(2):319-25. [Medline].

  19. Yip WC, Zimmerman F, Hijazi ZM. Heart block and empirical therapy after transcatheter closure of perimembranous ventricular septal defect. Catheter Cardiovasc Interv. Nov 2005;66(3):436-41. [Medline].

  20. Predescu D, Chaturvedi RR, Friedberg MK, Benson LN, Ozawa A, Lee KJ. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg. Nov 2008;136(5):1223-8. [Medline].

  21. Szkutnik M, Kusa J, Bialkowski J. Percutaneous closure of perimembranous ventricular septal defects with Amplatzer occluders--a single centre experience. Kardiol Pol. Sep 2008;66(9):941-7; discussion 948-9. [Medline].

 
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A: Image shows a ventricular septum viewed from the right side. It has the following 4 components: inlet septum from the tricuspid annulus to the attachments of the tricuspid valve (I); trabecular septum from inlet to apex and up to the smooth-walled outlet (T); outlet septum, which extends to the pulmonary valve (O); and membranous septum. B: Anatomic positions of the defects are as follows: outlet defect (a); papillary muscle of the conus (b); perimembranous defect (c); marginal muscular defects (d); central muscular defects (e); inlet defect (f); and apical muscular defects (g).
Schematic representation of the location of various types of ventricular septal defects (VSDs) from the right ventricular aspect. A = Doubly committed subarterial ventricular septal defect; B = Perimembranous ventricular septal defect; C = Inlet or atrioventricular canal–type ventricular septal defect; D = Muscular ventricular septal defect.
Supracristal ventricular septal defect (VSD). Top image: Parasternal long-axis view shows the defect just below the aortic root. Middle image: The plane of sound is tilted to view the right ventricular outflow tract, and the defect is observed below the pulmonic valve. Bottom image: Parasternal short-axis view shows the ventricular septal defect between the aortic root (Ao) and the pulmonic valve (PV). LA = Left atrium; LV = Left ventricle; PA = Pulmonary artery; RA = Right atrium; RV = Right ventricle.
Echocardiogram of a child with a perimembranous ventricular septal defect (VSD). Note the defect at the 10 o'clock position in the parasternal short-axis view. AO = Aortic root; LA = Left atrium; LV = Left ventricle; PA = Pulmonary artery; RA = Right atrium; RV = Right ventricle.
Apical 4-chamber views. A: Image shows a large inlet defect. The defect is posterior and at the level of the atrioventricular valves. B: Image shows a small midmuscular ventricular septal defect. LA = Left atrium; LV = Left ventricle; PA = Pulmonary artery; RA = Right atrium; RV = Right ventricle.
Table. Aneuploid Syndromes Associated with Ventricular Septal Defect
SyndromeCCVM (%)Type of CCVM
Del 4q, 21, 3260Ventricular septal defect, atrial septal defect
Del 5p30-60Ventricular septal defect
Trisomy 1380Atrial septal defect, ventricular septal defect, TOF
Trisomy 18, Edwards syndrome100Ventricular septal defect, TOF, double-outlet right ventricle (DORV)
Trisomy 21, Down syndrome40-50Ventricular septal defect, atrioventricular canal (AVC)
Del 22q11, DiGeorge syndrome (single gene etiology, autosomal dominant)50Truncus arteriosus, TOF, ventricular septal defect
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