Objective: To describe the spectrum of ventricular septal defects seen in children in Fiji.

Methods: We reviewed the clinical records and echocardiograms of children attending a screening clinic that was part of an annual visiting cardiac surgical team.

Results: A total of 519 children were examined between 2002 and 2008. Ages ranged from 1 day to18 years. Of the 136 with ventricular septal defects, 108 had perimembranous defects including 4 with an additional muscular defect, 24 had doubly committed juxta-arterial defects including 2 with an additional muscular defect and 4 had muscular defects, including 1 with multiple defects. Outlet extension was seen in 41% of perimembranous defects. Aortic valve prolapse was seen in 32% of perimembranous defects and in 67% of juxta-arterial defects. Aortic regurgitation occurred in 24% of all ventricular septal defects; 22% of these were graded as moderate or severe. We frequently observed a distorted right coronary cusp bulging into and partially closing a large defect. In the most extreme cases, the aorta appeared to be displaced anteriorly through the defect.

Conclusion: Doubly committed juxta-arterial and perimembranous ventricular septal defects with outlet extension are common in this group. Aortic valve prolapse and regurgitation frequently complicate these lesions. It is especially important to consider the aortic valve in surgical decision making in this population.