cardiac failure - this is caused by fluid overload of the affected ventricle(s).
infective endocarditis - the risk of developing this condition is related to the degree of roughening of the endocardium by high-velocity jets of blood. The risk is high with a small ventricular septal defect, but very low with a large atrial septal defect.
increasing pulmonary vascular resistance - the left to right shunts cause excessive pulmonary arterial pressure and pulmonary blood flow. These features cause progressive damage of the pulmonary vascular bed with medial thickening of the pulmonary arteries and later intimal changes raise the pulmonary vascular resistance and limit the blood flow into the lungs. The changes eventually become irreversible even if the cause of vascular stress is relieved by closing the left to right shunt; this is Eisenmenger's syndrome.
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