Which statement about ventricular septal defect is true?

Which statement about ventricular septal defect is true?

• A. All VSDs require immediate surgical repair
• B. Manifestations depend on the degree of shunting
• C. VSD never affects pulmonary circulation
• D. VSD causes cyanosis in all cases

Answer: (B)

Ventricular septal defect changes how much blood moves from the left ventricle to the right ventricle, and the clinical presentation depends on that amount of shunting. A small defect typically causes little left-to-right shunt, may be asymptomatic, and often has a loud murmur with normal growth. A large defect allows substantial blood to flow into the pulmonary circulation, leading to pulmonary overcirculation, tachypnea, feeding difficulties, and signs of congestive heart failure in infancy. Over time, constant high flow to the lungs can cause pulmonary vascular remodeling and, if the pressure in the lungs rises enough, reversal of the shunt (Eisenmenger syndrome) with cyanosis—though cyanosis is not seen in all cases. Because the degree of shunting drives the symptoms and outcomes, this statement is the best description. Not all VSDs require immediate surgical repair; some small defects close spontaneously or are managed conservatively if the child remains well. VSDs do affect pulmonary circulation through increased blood flow to the lungs, which can cause respiratory symptoms or heart failure depending on shunt size. Cyanosis is not universal; it occurs mainly if a long-standing large shunt leads to Eisenmenger physiology.

Ventricular septal defect changes how much blood moves from the left ventricle to the right ventricle, and the clinical presentation depends on that amount of shunting. A small defect typically causes little left-to-right shunt, may be asymptomatic, and often has a loud murmur with normal growth. A large defect allows substantial blood to flow into the pulmonary circulation, leading to pulmonary overcirculation, tachypnea, feeding difficulties, and signs of congestive heart failure in infancy. Over time, constant high flow to the lungs can cause pulmonary vascular remodeling and, if the pressure in the lungs rises enough, reversal of the shunt (Eisenmenger syndrome) with cyanosis—though cyanosis is not seen in all cases. Because the degree of shunting drives the symptoms and outcomes, this statement is the best description.

Not all VSDs require immediate surgical repair; some small defects close spontaneously or are managed conservatively if the child remains well. VSDs do affect pulmonary circulation through increased blood flow to the lungs, which can cause respiratory symptoms or heart failure depending on shunt size. Cyanosis is not universal; it occurs mainly if a long-standing large shunt leads to Eisenmenger physiology.