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The definitive diagnostic test for ventricular septal defect is:

  1. Doppler echocardiography
  2. Cardiac catheterization

presumptive diagnosis can be made with:

  1. Auscultation of a right sternal border systolic heart murmur.
  2. Radiographic evidence of pulmonary overcirculation.

The re-circulation circuit is: right ventricle, right ventricular outflow tract, pulmonary arteries, pulmonary veins, left atrium and left ventricle.

Diagnostic Findings:

  1. Radiology may show:
    • generalized heart enlargement
    • pulmonary overcirculation
  2. ECG may show:
    • usually normal ECG
    • possibly left ventricular enlargement
    • variable right ventricular enlargement
  3. Echocardiography:
    • VSD defect
    • Generalized heart enlargement
    • Doppler evidence of a left to right VSD

Comment (Right to left VSD): It is reported that chronic large volume of flow across the VSD into the pulmonary arteries can result in pulmonary artery hypertension and elevated right ventricular pressure. This can eventually result in right to left flow across the VSD.

It is my belief that a right to left shunt does not occur due to this etiology of excessive blood flow as described in man. When a right to left shunt does occur it is a result of a hypoplastic pulmonary vasculature or congenital pulmonary artery hypertension.

When right to left flow occurs across the VSD:

  1. Historical signs develop:
    • reduced exercise tolerance
    • syncope
    • fatigue
  2. Physical examination signs develop:
    • jugular venous distention
    • cyanosis
    • weakness
    • possibly heart murmur
  3. Radiologic signs develop:
    • right ventricular enlargement
    • right atrial enlargement
    • pleural effusion
    • ascites
  4. Electrocardiographic signs develop:
    • right ventricular enlargement
    • right atrial enlargement
  5. Blood work findings develop:
    • reduced arterial oxygen content
  6. Echocardiographic findings develop:
    • right ventricular enlargement
    • right atrial enlargement
    • right to left contrast flow across VSD