Pediatric Ventricular Septal Defect

  • Etiology: Types:
    — Outlet-supracrystal (5%) associated with truncus arteriosus and Tetralogy of Fallot
    — Membranous (80%)
    — Inlet (5%) associated with atrioventricular canal defect
    — Muscular (10%)
  • Imaging: Intracardiac left to right shunt leads to acyanosis and increased pulmonary blood flow
  • Imaging CXR:
  • DDX:
  • Complications: Long-term untreated ventricular septal defect may lead to Eisenmenger physiology
  • Treatment:
  • Clinical:
    — Most common congenital heart disease
    — 33% resolve spontaneously
    — Present in second month when pulmonary vascular resistance decreases and a shunt can develop so therefore most common cause of shunt vascularity in infants and children but not in neonates

Radiology Cases of Ventricular Septal Defect

CXR of ventricular septal defect
CXR AP shows a left aortic arch, an enlarged cardiac silhouette, and marked pulmonary vascular congestion.
CXR of right aortic arch with aberrant left subclavian artery in a patient with ventricular septal defect
CXR AP shows a right-sided aortic arch, cardiomegaly, and marked pulmonary vascular congestion.

Radiology Cases of Eisenmenger Syndrome Due to Ventricular Septal Defect

CXR of Eisenmenger syndrome due to ventricular septal defect / VSD
CXR AP at 4 years of age (above) shows mild prominence of the pulmonary arteries bilaterally. CXR AP at 24 years of age (below) shows marked enlargement of the pulmonary arteries bilaterally with peripheral pruning of the pulmonary vasculature.