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
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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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.
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.
Obtain prior operative/catheter records and perform examination including upper- and lower-limb saturation.
Use expert TTE to define lesion, shunt, ventricular effects, valves and pulmonary pressure.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.