Skip to textbook content
Doctor’s PassportTextbook
TopicsAll topics

Loading topic navigation…

Textbook navigation
TopicsAll topics

Loading topic navigation…
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Ventricular septal defect and patent ductus arteriosus

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
!
Escalate

New cyanosis, haemoptysis, syncope, infective-endocarditis features or decompensated heart failure in an adult with VSD/PDA needs urgent ACHD assessment; do not arrange routine closure when Eisenmenger physiology is possible.

Synopsis

Recognise residual or unrepaired VSD and PDA in adults, identify closure indications and avoid intervention after irreversible pulmonary vascular disease.

  • A small restrictive VSD can produce a loud pansystolic murmur despite a small shunt.
  • A large VSD causes left-heart volume loading and, if uncorrected, pulmonary vascular disease and shunt reversal.
  • PDA classically causes a continuous left infraclavicular murmur, bounding pulses and wide pulse pressure when the shunt is substantial.
  • TTE defines most lesions; CMR or CT quantifies anatomy and flow when echo is incomplete.
  • Consider closure for significant left-to-right shunt with left-ventricular volume overload when pulmonary vascular resistance is acceptable.
  • VSD closure may also be considered for progressive aortic regurgitation from cusp prolapse or recurrent endocarditis.
  • Do not close a VSD or PDA in established Eisenmenger syndrome or irreversible severe pulmonary vascular disease.

Key red flags

Eisenmenger conversion

Cyanosis, clubbing, erythrocytosis, haemoptysis or syncope signals advanced pulmonary vascular disease and makes closure hazardous.

Investigation priorities

01
Transthoracic echocardiographyFirst step

Define defect/duct, direction and velocity of flow, chamber size, valves and estimated pulmonary pressure.

Management branches

FirstNew or residual VSD/PDA

Characteristic murmur, unexplained chamber dilatation, cyanosis or known childhood lesion.

  1. Obtain prior operative/catheter records and perform examination including upper- and lower-limb saturation.
  2. Use expert TTE to define lesion, shunt, ventricular effects, valves and pulmonary pressure.
  3. Refer adults with more than a trivial lesion, symptoms, aortic regurgitation or suspected PH to an ACHD service.
  4. Use CMR/CT and catheterisation when anatomy or operability is uncertain.
Open full textbook →Answer 2 questionsCardiology check
Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • ESC 2020 adult congenital heart disease guidelineVSD, PDA, haemodynamics and intervention.
  • NHS England adult congenital heart servicesUK specialist service framework.
  • NICE CG64: infective endocarditis prophylaxisNational dental-prophylaxis recommendation.
  • NICE structural heart defect guidanceRelevant interventional procedures.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom