Communications interventriculaires

Isolated ventricular septal defect (VSD) is the most common congenital cardiac malformation. VSD is also the most frequent defect associated to others congenital cardiovascular malformations. The numerous anatomic varieties of VSD explain the great variability of the clinical features and the differences in the natural history. With echocardiography and colour Doppler, the diagnosis of VSD is easier and more accurate than previously; so, pre-operative catheterization is no longer needed in most of the cases. The course of VSDs, depending on their size and location, may be early predicted in analysing their anatomic aspect by repeated echocardiography Doppler during the first months of life. Most of them become proportionally smaller with time and, finally, close spontaneously during infancy, childhood or adolescence. Few VSDs need early surgical closure to avoid complications of a large left-to-right shunt, such as cardiac failure and pulmonary hypertension secondary to a severe damage of pulmonary arteries. This management prevents Eisenmenger's syndrome, an irreversible situation corresponding to an inversion of the shunt in relation to high pulmonary vascular resistance. When VSD persists in adults, others complications such as infective endocarditis and aortic regurgitation may occur; therefore, strict surveillance and antibiotic prophylaxis are recommended in concerned patients. Owing to the improvement of cardiac surgery in low weight infants, the surgical closure of large VSD in infancy gives currently excellent results. Apical muscular VSD and multiple muscular VSD still present a particular surgical challenge: today, their closure may be achieved using a ventricular septal device during surgery or interventional catheterization. In this article, only isolated VSDs will be considered. Indeed, VSDs that constitute an integral part of a more complex malformation, such as the “tetralogie de Fallot” or complete atrio-ventricular defect, have a different presentation and require a specific treatment. Persistent VSD after correction of another cardiac malformation (aortic coarctation, transposition of great arteries, etc .) may be assimilated to isolated VSDs because they have usually similar clinical features and outcome.