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

A. Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood.

B. Tachypnea and failure to thrive are symptoms frequently associated with large VSDs

D. Patients with a large VSD and low pulmonary vascular resistance can present with a middiastolic murmur at the apex.

DISCUSSION: Spontaneous and complete closure of VSDs, even large ones, has been estimated to occur in 25% to 50% of patients during childhood. The probability of eventual spontaneous closure is inversely related to the age at which the patient is observed. Tachypnea, poor feeding, growth failure, recurrent respiratory infections, exercise intolerance, and severe cardiac failure may develop in patients with large VSDs. Patients with Eisenmenger's complex are cyanotic, polycythemic, and severely limited in their exercise tolerance, owing to markedly elevated pulmonary vascular resistance associated with a predominantly right-to-left shunt across the VSD. A middiastolic murmur can be present at the apex in patients with a large VSD associated with low pulmonary vascular resistance. This indicates high pulmonary blood flow with a large flow across the mitral valve into the left ventricle.