Two ways: A large vsd with increased pulmonary blood flow may cause a diastolic flow rumble caused by a large amount of flow coming back from the lungs across the mitral valve into the left ventricle. Perimembranous and supracristal vsds can cause aortic valve deformation, and subsequent development of a diastolic murmur of aortic valve insufficiency.
Answered 12/24/2014
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