Cardiovascular System - Ventricular Septal Defects

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Ventricular Septal Defect

The Ventricular Septal Defect (VSD) is the most common form of congenital cardiovascular anomaly, occurring in nearly 50% of all infants with a congenital heart defect. Usually occurs in the membranous (perimembranous) rather than muscular interventricular septum, and is more frequent in males that females.

Perimembranous defects are located close to the aortic and tricuspid valves and adjacent to atrioventricular conduction bundle.

Heart Abnormal: Tutorial Abnormalities | atrial septal defects | double outlet right ventricle | hypoplastic left heart | patent ductus arteriosus‎ | transposition of the great vessels | Tetralogy of Fallot | ventricular septal defects | coarctation of the aorta | Category ASD | Category PDA | Category ToF | Category VSD | ICD10 - Cardiovascular | ICD11
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Historic Embryology - Cardiovascular 
1902 Vena cava inferior | 1905 Brain Blood Vessels | 1909 Cervical Veins | 1909 Dorsal aorta and umbilical veins | 1912 Heart | 1912 Human Heart | 1914 Earliest Blood-Vessels | 1915 Congenital Cardiac Disease | 1915 Dura Venous Sinuses | 1916 Blood cell origin | 1916 Pars Membranacea Septi | 1919 Lower Limb Arteries | 1921 Human Brain Vascular | 1921 Spleen | 1922 Aortic-Arch System | 1922 Pig Forelimb Arteries | 1922 Chicken Pulmonary | 1923 Head Subcutaneous Plexus | 1923 Ductus Venosus | 1925 Venous Development | 1927 Stage 11 Heart | 1928 Heart Blood Flow | 1935 Aorta | 1935 Venous valves | 1938 Pars Membranacea Septi | 1938 Foramen Ovale | 1939 Atrio-Ventricular Valves | 1940 Vena cava inferior | 1940 Early Hematopoiesis | 1941 Blood Formation | 1942 Truncus and Conus Partitioning | Ziegler Heart Models | 1951 Heart Movie | 1954 Week 9 Heart | 1957 Cranial venous system | 1959 Brain Arterial Anastomoses | Historic Embryology Papers | 2012 ECHO Meeting | 2016 Cardiac Review | Historic Disclaimer

Some Recent Findings

  • Complete Repair of Coarctation of the Aorta and a Ventricular Septal Defect in a 1,480 g Low Birth Weight Neonate[1] "Although outcomes of neonatal cardiac surgery have dramatically improved in the last two decades, low body weight still constitutes an important risk factor for morbidity and mortality. In particular, cardiac surgery in neonates with very low birth weight (≤1.5 kg) is carried out with greater risk because most organ systems are immature. We report here on a successful case of early one-stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,480 gram neonate."


Le Gros Clark (1847)[2] Heart autopsy drawing.

The first western clinical description of ventricular septal defects was made by Henri Roger in 1879[3], which later became known as maladie de Roger.

His description was based upon 6 acyanotic patients and autopsy finding of a child with ventricular septal defect.

Pulmonary Changes

Heath-Edwards classification

Artery normal histology

(Heath-Edward grade) A pathological grading system for pulmonary artery structural changes that occur with congenital cardiac septal defects. The classification is named after the two original paper authors Donald HEATH and Jessee EDWARDS[4] and grades from I to VI with increasing severity of the arterial changes.

  1. Grade I - hypertrophy of the media of small muscular arteries and arterioles.
  2. Grade II - intimal cellular proliferation in addition to medial hypertrophy.
  3. Grade III - advanced medial thickening with hypertrophy and hyperplasia including progressive intimal proliferation and concentric fibrosis. Results in an obliteration of the arterioles and small arteries.
  4. Grade IV - "plexiform lesions" of the muscular pulmonary arteries and arterioles with a plexiform network of capillary-like channels within a dilated segment.
  5. Grade V - complex plexiform, angiomatous and cavernous lesions and hyalinization of intimal fibrosis.
  6. Grade VI - necrotizing arteritis.

International Classification of Diseases

The International Classification of Diseases (ICD) World Health Organization's classification used worldwide as the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems. Within this classification "congenital malformations, deformations and chromosomal abnormalities" are (Q00-Q99) but excludes "inborn errors of metabolism" (E70-E90).

Congenital malformations of the circulatory system (Q20-Q28)

ICD-10 Code: Q21.0 Ventricular septal defect

Q21 Congenital malformations of cardiac septa

Excl.: acquired cardiac septal defect (I51.0)

  • Q21.0 Ventricular septal defect
  • Q21.1 Atrial septal defect Coronary sinus defect Patent or persistent: foramen ovale ostium secundum defect (type II) Sinus venosus defect
  • Q21.2 Atrioventricular septal defect Common atrioventricular canal Endocardial cushion defect Ostium primum atrial septal defect (type I)
  • Q21.3 Tetralogy of Fallot Ventricular septal defect with pulmonary stenosis or atresia, dextroposition of aorta and hypertrophy of right ventricle.
  • Q21.4 Aortopulmonary septal defect Aortic septal defect Aortopulmonary window
  • Q21.8 Other congenital malformations of cardiac septa Eisenmenger's defect Pentalogy of Fallot Excl.: Eisenmenger's complex (I27.8) syndrome (I27.8)
  • Q21.9 Congenital malformation of cardiac septum, unspecified Septal (heart) defect NOS


Heart1 realign icon.jpg
 ‎‎Heart Realign
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 ‎‎Outflow Septation
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Heart septation 001 icon.jpg
 ‎‎Cardiac Septation
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Outflow tract 001 icon.jpg
 ‎‎Outflow Tract
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 ‎‎Ventricular Septum 1
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 ‎‎Ventricular Septum 2
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 ‎‎Ventricular Septum 3
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Cardiovascular Abnormalities

Data shown as a percentage of all major abnormalities based upon published statistics using the same groupings as Congenital Malformations Australia 1981-1992 P. Lancaster and E. Pedisich ISSN 1321-8352.

Heart defects and preterm birth are the most common causes of neonatal and infant death. The long-term development of the heart combined with extensive remodelling and post-natal changes in circulation lead to an abundance of abnormalities associated with this system.

A UK study literature showed that preterm infants have more than twice as many cardiovascular malformations (5.1 / 1000 term infants and 12.5 / 1000 preterm infants) as do infants born at term and that 16% of all infants with cardiovascular malformations are preterm. (0.4% of live births occur at greater than 28 weeks of gestation, 0.9% at 28 to 31 weeks, and 6% at 32 to 36 weeks. Overall, 7.3% of live-born infants are preterm)[5]

"Baltimore-Washington Infant Study data on live-born cases and controls (1981-1989) was reanalyzed for potential environmental and genetic risk-factor associations in complete atrioventricular septal defects AVSD (n = 213), with separate comparisons to the atrial (n = 75) and the ventricular (n = 32) forms of partial AVSD. ...Maternal diabetes constituted a potentially preventable risk factor for the most severe, complete form of AVSD." [6]

In addition, there are in several congenital abnormalities that exist in adults (bicuspid aortic valve, mitral valve prolapse, and partial anomalous pulmonary venous connection) which may not be clinically recognized.


  1. <pubmed>22263148</pubmed>
  2. <pubmed>20895864</pubmed>| PMC2104017 | PDF
  3. <pubmed>382810</pubmed>
  4. <pubmed>13573570</pubmed>Circulation
  5. <pubmed>16322141</pubmed>
  6. <pubmed>11241431</pubmed>




<pubmed>22263148</pubmed> <pubmed>22229525</pubmed> <pubmed>22163127</pubmed> <pubmed>3808993</pubmed> <pubmed>2938464</pubmed> <pubmed>6179217</pubmed>

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Cite this page: Hill, M.A. (2021, March 2) Embryology Cardiovascular System - Ventricular Septal Defects. Retrieved from

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