A ventricular septal defect (VSD) is a hole or a defect in the septum that divides the 2 lower chambers of the heart

and that results in a communication between the ventricular cavities. The defect may occur as a primary anomaly with or without additional major associated cardiac defects. At 4-8 weeks' gestation, the single ventricular chamber is effectively divided into two. This division is accomplished with the fusion of the membranous portion of the ventricular septum, the endocardial cushions, and the bulbous cordis (proximal portion of the truncus arteriosus).

Classification Many classifications of ventricular septal defects have been proposed. An underlying classification that is surgically and clinically useful is described below.

1. Perimembranous (infracristal, conoventricular) ventricular septal defects lie in the LV

outflow tract just below the aortic valve. Because they occur in the membranous septum with defects in the adjacent muscular portion of the septum, they are subclassified as perimembranous inlet, perimembranous outlet, or perimembranous muscular. These are the most common types of ventricular septal defects and account for 80% of such defects. Perimembranous ventricular septal defects are associated with pouches or aneurysms of the septal leaflet of the tricuspid valve, which can partially or completely close the defect. In addition, an LV-to-RA shunt may be associated with this defect. 2. Supracristal (conal septal, infundibular, subpulmonic, subarterial, subarterial doubly committed, outlet) ventricular septal defects account for 5-8% of isolated ventricular septal defects in the United States but 30% of isolated ventricular septal defects in Japan. These defects lie beneath the pulmonic valve and communicate with the RV outflow tract above the supraventricular crest and are associated with aortic regurgitation secondary to the prolapse of the right aortic cusp. 3. Muscular ventricular septal defects (trabecular) are entirely bounded by the muscular septum and are often multiple. The term Swiss-cheese septum has been used to describe multiple muscular ventricular septal defects. Other subclassifications depend on the location and include central muscular or midmuscular, apical, or marginal when the defect is along the RV-septal junction. These ventricular septal defects account for 5-20% of all defects. Any single defect observed from the LV aspect may have several openings on the RV aspect. 4. Posterior (canal-type, endocardial cushiontype, AV septumtype, inlet, juxtatricuspid) ventricular septal defects lie posterior to the septal leaflet of the tricuspid valve. Although locations of posterior ventricular septal defects are similar to those of ventricular septal defect observed with AV septal defects, they are not associated with defects of the AV valves. About 8-10% of ventricular septal defects are of this type.