What criteria should I use to determine when to refer an adult with a suspected VSD for specialist evaluation?

Referral criteria for an adult with suspected ventricular septal defect (VSD) for specialist evaluation:

• Refer adults with suspected congenital heart defects such as VSD for specialist assessment if they present with a murmur suggestive of structural heart disease, especially if accompanied by symptoms such as breathlessness, exertional syncope, or signs of heart failure.
• Consider urgent referral (within 2 weeks) for specialist assessment including echocardiography if the adult has a systolic murmur and exertional syncope or severe symptoms (angina or breathlessness on minimal exertion or at rest) that may be related to the defect.
• Offer echocardiography to adults with a murmur and suspected valve or structural heart disease based on murmur characteristics, family history, age, or medical history.
• Refer to a specialist after echocardiography if moderate or severe structural heart disease is identified, or if there is evidence of complications such as left ventricular dysfunction or heart failure.
• Adults with mild defects without symptoms may be monitored but should be referred if symptoms develop or if echocardiographic findings worsen.

These criteria align with the general principles for referral of adults with suspected structural or valvular heart disease for specialist evaluation and echocardiography as outlined in NICE guideline NG208 ¹.