Guide to Ventricular Septal Defect

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A ventricular septal defect (VSD) is an opening, or hole, in the muscular wall, or septum, separating the two lower chambers of the heart, known as the right and left ventricles. This opening can disrupt the normal flow of blood, causing the heart and lungs to work harder and leading to additional complications. Depending on the severity of the defect, surgical repair may be needed.

Key Facts

Normally, the heart’s septum keeps oxygen-rich blood separated from oxygen-poor blood in the chambers of the heart. In babies with VSD, oxygen-rich blood from the left ventricle mixes with oxygen-poor blood from the right ventricle, which can cause the heart and lungs to work harder.
VSDs can range in size and consist of one or more holes. In most cases, the holes are small and will close on their own. However, medium or large holes can lead to a range of complications, including high blood pressure, heart infection, and heart failure.
If treatment is needed, VSDs can be repaired through both corrective open-heart surgery and minimally invasive options, such as cardiac catheterization. The best treatment will depend on the size and severity of the condition.

Causes

Ventricular septal defects are congenital, which means they are present at birth. A VSD happens when the septum separating the left and right ventricles of the heart does not form completely during fetal development.

The holes allow blood to pass through the septal defect to the other side of the heart where it doesn’t belong. When oxygen-rich and oxygen-poor blood mix, the overall quality of oxygenation in the blood drops, which can lead to the heart and lungs needing to work harder.

The exact causes of VSDs are still unknown, but both genetic and environmental risk factors may play a role. VSDs can occur by themselves or alongside other congenital heart defects.

Symptoms

Symptoms of a VSD will depend on its severity. Small defects may not produce any symptoms and can go undetected until long after birth. However, larger or more numerous VSDs may bring on symptoms such as:

Shortness of breath
Faster or harder breathing
Sweating
Difficulty feeding
Poor weight gain

Left untreated, a VSD can potentially lead to more serious complications, such as:

Pulmonary hypertension: A VSD allows more blood to flow into the lungs, which can increase the blood pressure in the lung’s arteries and cause permanent damage.
Endocarditis: This is a type of heart infection caused by bacteria that can lead to life-threatening inflammation.
Heart failure: The longer and harder the heart has to work to compensate for the irregular blood flow, the higher the risk of heart failure.

Diagnosis

If it is large enough to produce symptoms, a VSD can typically be diagnosed shortly after birth. This usually occurs during a physical examination when the provider hears the distinct whooshing sound of a heart murmur, which can indicate irregular blood flow. The diagnosis can be confirmed with a number of tests:

Cardiac catheterization: This procedure can be used to detect heart defects as well as how much blood is flowing to the lungs. It involves inserting a thin, flexible tube called a catheter into a blood vessel and up into the heart so different measurements can be taken.
Chest X-ray: This test creates a detailed picture of the heart and lungs, allowing doctors to check for signs of defects.
Echocardiogram: This technique uses sound waves to produce an image of the heart. Doctors can use it to see the heart beating and pumping blood while they look for defects.
Electrocardiogram: This test measures the electrical activity of the heart. Sensors called electrodes are attached to the patient’s arms, legs, and chest to measure how well the heart is beating.
Magnetic resonance imaging (MRI): This test uses magnetic fields to create detailed images of the heart and blood vessels. Doctors can use it to locate the VSD, determine its severity, and guide treatment.

Treatment

In most cases, babies born with a small VSD will require minimal to no treatment. Instead, they will be monitored closely and their symptoms treated while they wait for the VSD to close on its own. More severe VSDs or those located in unusual areas that could cause damage to other parts of the heart will usually require treatment within the patient’s first year.

Treatment methods for VSDs include:

Surgical closure: This method requires open-heart surgery to close the VSD with either stitches or a patch made from a synthetic material or the patient’s own pericardium, the membrane that surrounds the heart.
Catheter-based repair: This procedure involves inserting a catheter into a blood vessel in the groin and guiding it up to the heart using X-rays. Once it reaches the VSD, a mesh device at the end of the catheter is used to close the hole.

While there are no medications for treating VSDs, doctors may prescribe diuretics to reduce the amount of blood being pumped in order to prevent too much blood from collecting in the lungs.

Outlook

The long-term outlook for a VSD is extremely good. In 85–90% of cases, small VSDs will close on their own, without the need for further intervention. For more severe defects, proper diagnosis and treatment typically means that patients will go on to lead normal, healthy lives.

However, anyone who has had a VSD should have follow-ups with a cardiologist every few years to make sure it remains closed and that no other complications are present. Long-term management considerations include:

Pregnancy: While small and/or previously repaired VSDs pose minimal risk while pregnant, unrepaired larger VSDs can pose a high risk to expectant mothers. It is important to talk with a cardiologist before becoming pregnant.
Endocarditis: People who have recently undergone surgical repair of a VSD with artificial material, as well as those who still have leaks through a VSD, may be at an increased risk of developing endocarditis.To reduce this risk, it may be necessary to take antibiotics.
Activity: While small and previously repaired VSDs typically won’t require patients to limit their exercise, those who still have irregular blood flow may need to restrict certain activities. A cardiologist can help determine appropriate levels of activity.

Next Steps

If your child has a congenital heart issue such as VSD, the Congenital Heart Center can help. Our team can offer personalized treatment plans delivered with a level of quality that could only come from one of the most experienced programs in the country.

Call us at 212-305-2688 or use our online form to schedule an appointment.