Which of the following statements about VSDs is/are true?

A. When coarctation of the aorta is associated with VSD, it most commonly occurs in infants with large lesions who have to undergo repair before age 3 months.

B. In some patients with VSD, aortic valve incompetence develops over time and progresses.

D. PDA is present in approximately one fourth of infants with a VSD and concomitant congestive heart failure.

DISCUSSION: VSD in combination with severe coarctation of the aorta occurs in approximately 17% of patients. This combination is more common among infants with large VSDs undergoing operation before age 3 months. Aortic valve incompetence does develop over time in some patients with VSD, presumably as a result of progressive prolapse of the right aortic cusp through the defect. In the United States two thirds of patients with VSD and aortic insufficiency have perimembranous lesions and one third have a doubly committed or juxta-arterial lesion. In Japan, however, the reverse is true: two thirds have doubly committed or juxta-arterial lesions and one third have perimembranous lesions. A moderate- or largesized PDA is associated with VSD in approximately 6% of patients of all ages; however, in infants with VSD and concomitant congestive heart failure, PDA is present in approximately 25%.