A ventricular septal defect (VSD), a hole in the heart, is a common heart defect that’s present at birth (congenital).
The hole occurs in the wall that separates the heart’s lower chambers (septum) and allows blood to pass from the left to the right side of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to work harder. Congenital heart defects arise from problems early in the heart’s development, but there’s often no clear cause. Genetics and environmental factors probably play a role. VSDs can occur alone or with other congenital heart defects.
Before a baby is born, the right and left ventricles of its heart are not separate. As the fetus grows, a wall forms to separate these two ventricles. If the wall does not completely form, a hole remains. This hole is known as a ventricular septal defect, or a VSD.
Ventricular septal defect is one of the most common congenital heart defects. The baby may have no symptoms, and the hole can eventually close as the wall continues to grow after birth. If the hole is large, too much blood will be pumped to the lungs, leading to heart failure. The cause of VSD is not yet known. This defect often occurs along with other congenital heart defects.
In adults, ventricular septal defects are a rare but serious complication of heart attacks. These holes do not result from a birth defect.
Listening with a stethoscope usually reveals a heart murmur. The loudness of the murmur is related to the size of the defect and amount of blood crossing the defect.
Tests may include:
A small ventricular septal defect may cause no problems, and many small VSDs close on their own. Larger VSDs need surgical repair early in life to prevent complications. Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child’s life. However, if the hole is large, the baby often has symptoms related to heart failure.
The most common symptoms include:
Ventricular septal defect symptoms in a baby may include:
You and your doctor may not notice signs of a ventricular septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if at all. Signs and symptoms vary depending on the size of the hole and other associated heart defects.
Your doctor may first suspect a heart defect during a regular checkup if he or she hears a murmur while listening to your baby’s heart with a stethoscope. Sometimes VSDs can be detected by ultrasound before the baby is born.
Sometimes a VSD isn’t detected until a person reaches adulthood. Signs and symptoms can include a heart murmur and shortness of breath your doctor hears when listening to your heart with a stethoscope.
If the defect is small, no treatment may be needed. But the baby should be closely monitored by a health care provider to make sure that the hole eventually closes properly and signs of heart failure do not occur.
Babies with a large VSD who have symptoms related to heart failure may need medicine to control the symptoms and surgery to close the hole. Medications may include digitalis (digoxin) and diuretics.
If symptoms continue, even with medication, surgery to close the defect with a patch is needed. Some VSDs can be closed with a special device during a cardiac catheterization, which avoids the need for surgery, but only certain types of defects can successfully be treated this way.
There are two types of surgery available to correct a VSD: the intra-cardiac technique and the trans-catheter technique. The surgical technique is chosen based upon the nature of the VSD and associated side effects on the patient’s heart and lungs. The intra-cardiac approach is the most common technique and is done while the patient is under cardiopulmonary bypass (a “heart-lung machine”) and is an open-heart operation. This is the procedure of choice for most children and at most pediatric surgical centers. A second technique uses surgical instruments that are passed through catheters placed in the patient’s large blood vessels into the heart. Having surgery for a VSD with no symptoms is controversial.
After a successful surgical repair of the VSD, the two ventricles are entirely separate from each other and the circulation of the blood within the heart is normal. If the heart was enlarged, it can return to a more normal size. The high pressure in the pulmonary artery should also begin to resolve. If the child’s growth had slowed, the child usually catches up within a year or two. Long-term follow-up is required. The long-term prognosis is usually excellent.
VSD is a hole in the wall separating the two lower chambers of the heart. In normal development, the wall between the chambers closes before the fetus is born, so that by birth, oxygen-rich blood is kept from mixing with the oxygen-poor blood. When the hole does not close, it may cause higher pressure in the heart or reduced oxygen to the body.
In most children, the cause isn’t known. It’s a very common type of heart defect. Some children can have other heart defects along with VSD.
Normally, the left side of the heart only pumps blood to the body, and the heart’s right side only pumps blood to the lungs. In a child with VSD, blood can travel across the hole from the left pumping chamber (left ventricle) to the right pumping chamber (right ventricle) and out into the lung arteries. If the VSD is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested.
If the opening is small, it won’t cause symptoms because the heart and lungs don’t have to work harder. The only abnormal finding is a loud murmur (noise heard with a stethoscope).
If the opening is large, the child may breathe faster and harder than normal. Infants may have trouble feeding and growing at a normal rate. Symptoms may not occur until several weeks after birth. High pressure may occur in the blood vessels in the lungs because more blood than normal is being pumped there. Over time this may cause permanent damage to the lung blood vessels.
If the opening is small, it won’t make the heart and lungs work harder. Surgery and other treatments may not be needed. Small VSDs often close on their own. There isn’t any medicine or other treatment that will make the VSD get smaller or close any faster than it might do naturally.
If the opening is large, open-heart surgery may be needed to close it and prevent serious problems. Babies with VSD may develop severe symptoms and early repair, within the first few months, is often necessary. The repair may be delayed in other babies. Medicines may be used temporarily to help with symptoms, but they don’t cure the VSD or prevent permanent damage to the lung arteries.
Closing a large VSD by open-heart surgery usually is done in infancy or childhood even in patients with few symptoms, to prevent complications later. Usually a patch of fabric or pericardium (the normal lining around the outside of the heart) is sewn over the VSD to close it completely. Later this patch is covered by the normal heart lining tissue and becomes a permanent part of the heart. Some defects can be sewn closed without a patch. It may be possible to close some VSDs in the cath lab.
If an infant is very ill, or has more than one VSD or a VSD in an unusual location, a temporary operation to relieve symptoms and high pressure in the lungs may be needed. This procedure (pulmonary artery banding) narrows the pulmonary artery to reduce the blood flow to the lungs. When the child is older, an operation is done to remove the band and fix the VSD with open-heart surgery.
If the VSD is small, or if the VSD has been closed with surgery, your child may not need any special precautions regarding physical activity and can participate in normal activities without increased risk.
Depending on the location of the VSD, your child’s pediatric cardiologist will examine your child periodically to look for uncommon problems, such as a leak in the aortic valve. Rarely, older children with small VSDs may require surgery if they develop a leak in this heart valve. After surgery to close a VSD, a pediatric cardiologist will examine your child regularly. The cardiologist will make sure that the heart is working normally. The long-term outlook is good and usually no medicines or additional surgery are needed.
Ask about your child’s risk of endocarditis. Your child’s cardiologist may recommend that your child receive antibiotics before certain dental procedures for a period of time after VSD repair.
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