Ventricular Septal Defect
photo and audio recording by Janelle Aby, MD interactive image provided by http://expand2web.com
The most common cardiac abnormality encountered in the newborn nursery is an isolated VSD. The murmur is frequently not heard at birth, but as the ductus arteriosus closes and the pressure gradient between the two ventricles becomes greater, a harsh murmur at the lower left sternal border can be heard, often on day 2 or 3. Although this diagnosis can be frightening to parents, many VSDs will close spontaneously over the course of several weeks to months.
When listening to the murmur of VSD, note that it is loudest at the left lower sternal border (this murmur was graded 2/6). It has a harsh, jet-like quality and is systolic. Although VSD murmurs are typically described as holosystolic, this can be difficult to appreciate in a newborn. Here, both S1 and S2 are clearly heard. An echocardiogram confirmed the presence of perimembranous VSD.
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