Ventricular septal defects are the most common form of congenital heart disease. If all newborns are examined about 3% would reveal tiny muscular VSDs. Spontaneous closure occurs by age 3 in greater than 50% of patients born with VSDs. Still, VSDs after age 2 represent the most common lesion if bicuspid aortic valves are not included in the equation. Occasionally children, however, may not experience spontaneous closure up until age 10.
A. Clinical Features
Small VSDs are usually asymptomatic. Oxygenated blood rushes from the left ventricle through a hole in the septum that separates the right and left ventricles (see Fig. 1). The blood traverses this hole at high velocity and sets up turbulence that is heard as a murmur with a stethoscope. The murmur is produced as the left ventricle contracts in systole. A harsh systolic murmur is heard with maximal intensity at the left lower sternal border and is well heard to the left and right of the sternum with less intensity at the apex of the heart. The murmur radiates from the point of maximal intensity like the spokes of a wheel. A thrill may be felt with the palm of the hand in the region where the murmur was best heard with the stethoscope. Because of these typical features the diagnosis can usually be made with the simple stethoscope.

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