Ventricular Septal Defect (VSD)
What is a ventricular septal defect?
A ventricular septal defect (VSD) is a congenital heart defect. This means that your
baby is born with it. A VSD is a hole in the wall (septum) that separates the 2 lower
chambers of the heart (right and left ventricles). VSDs are the most common type of
congenital heart defect.
The heart has 4 chambers: 2 upper (atria) and 2 lower (ventricles). Blood that is
high in oxygen flows from the left atrium to the left ventricle and out to the body,
where the vital organs use the oxygen. Blood with less oxygen flows from the right
atrium to the right ventricle and out to the lungs. In the lungs it picks up more
oxygen.
Normally. the septal wall prevents the mixing of blood between the two ventricles
of the heart. A VSD allows oxygen-rich (red) blood to pass abnormally from the left
ventricle through the opening in the septum. Then it mixes with oxygen-poor (blue)
blood in the right ventricle.
A large VSD can cause high pressure in the blood vessels in the lungs. The higher
pressure can lead to lower oxygen levels in the body. If your child has a larger VSD,
he or she may need some type of repair. Babies and children with larger VSDs often
have symptoms such as breathing faster and harder than normal. Very small holes in
the ventricular septum may not let much blood pass between the ventricles. In these
cases, the heart and lungs don’t have to work harder. Sometimes these small holes
will close up on their own.
There are different types of VSD. The type your child has depends on which part of
the wall between the ventricles is involved. The size of the opening or hole also
varies.
What causes a VSD?
VSD may occur more often in some families. This is because of gene problems. Most
of the time, doctors don't know the cause of VSD.
What are the symptoms of a VSD?
Your child may have symptoms from birth. Or your child may not have symptoms until
they are a little older. The size of the opening or hole affects how severe your child’s
symptoms are. So does the age at which your child first has symptoms. If the hole
is small, the only sign may be a heart murmur that your healthcare provider hears
with a stethoscope. With a larger opening, the heart and lungs have to work harder.
This can cause symptoms such as :
Symptoms can occur a bit differently in each child. The symptoms of VSD may also be
similar to symptoms of other conditions. Make sure your child sees the healthcare
provider for a correct diagnosis.
How is a VSD diagnosed?
Your child's healthcare provider may suspect a problem when they hear an abnormal
sound (heart murmur) when listening to your child's heart with a stethoscope. If this
happens, the healthcare provider may refer your child to a heart doctor for children
(pediatric cardiologist).
The heart doctor will check your child. He or she will listen to your child’s heart
and lungs. The details about the murmur will also help the heart doctor make the diagnosis.
The heart doctor may do tests to confirm the diagnosis. The tests your child has depends
on his or her age and condition, and the doctor’s preferences.
Chest X-ray
A chest X-ray shows the heart and lungs. With a VSD, a chest X-ray may show an enlarged
heart. This is because the left ventricle gets more blood than normal. There may also
be changes in the lungs because of extra blood flow.
Electrocardiogram (ECG)
This test records the electrical activity of the heart. It also shows abnormal rhythms
(arrhythmias) and spots heart muscle stress.
Echocardiogram (echo)
An echo uses sound waves to make a moving picture of the heart and heart valves. This
test can show the pattern and amount of blood flow through the septal opening. An
echo is used to diagnose VSD.
How is a VSD treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
A small VSD may close on its own as your child grows. Some small defects don’t close
on their own, but they still don’t need treatment. A larger VSD often needs to be
fixed with surgery or through cardiac catheterization. Once a child is diagnosed with
a VSD, their heart doctor will check the defect regularly to see if it’s closing on
its own.
Medicine
Some children may need to take medicine to help the heart work better. Children without
symptoms may not need medicine.
Good nutrition
Babies with a larger VSD may get tired when feeding. They may not be able to eat enough
to gain weight. They may need:
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High-calorie formula or breastmilk. Your child may need nutritional supplements added to his or her formula or pumped
breastmilk. This increases the number of calories in each ounce.
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Supplemental tube feedings. Your child may need to be fed through a small, flexible tube. This tube passes through
the nose, down the esophagus, and into the stomach. Your child may have tube feedings along
with or in place of bottle feedings. Babies who can drink part of their bottles may
be fed the rest through a feeding tube. Infants who are too tired to bottle-feed may
get all of their nutrition through the feeding tube.
Surgery
The goal of surgery is to close the septal opening before the lungs are damaged. Surgery
will also help babies who have trouble feeding gain a normal amount of weight. Your
child's heart doctor will decide when your child should have surgery. This may be
based on echocardiogram and cardiac catheterization results. In surgery, your child’s
doctor will close the VSD with stitches or a special patch. Ask your child’s heart
doctor for more information.
Cardiac catheterization
VSD may be fixed by a cardiac catheterization. In this test, a tool called a septal
occluder is used with a catheter. The doctor guides the catheter through the blood
vessels to the heart. Once the catheter is in the heart, the doctor closes defect
with the septal occluder. Only certain types of VSDs may be closed with this method.
This procedure should be done in centers that have staff with experience in doing
transcatheter VSD repair.
What are possible complications of a VSD?
Complications of an untreated VSD include:
Living with a VSD
Small VSDs
Babies with small VSDs may have no symptoms. These children may not need medicine.
They’ll still be checked often by their heart doctors. If a defect is going to close,
it usually happens by age 2 . But some defects don’t close until age 4 . These children
usually grow and develop normally. They also have no activity restrictions, and live
normal, healthy lives.
Moderate to severe VSDs
If the VSD is moderate to severe, your child’s heart doctor will closely monitor him
or her. The doctor will decide when and how your child’s VSD will be fixed. Before
surgery, your child may need medicine and special feedings. Your child's healthcare
team will give you information and support so you can care for your child at home.
Children who need surgery will be admitted to the hospital for surgery.
Babies who have trouble eating before surgery often have more energy right after surgery.
They start to eat better and gain weight faster.
After surgery, older children can often be active without getting too tired. Within
a few weeks, your child should be fully recovered. He or she should be able to do
normal activities. Your child’s healthcare team may give you instructions on how to
care for your child.
Most children who have surgery for VSD will live normal, healthy lives. Their activity
levels, appetite, and growth often return to normal. Your child's heart doctor may
give him or her antibiotics to prevent infections after leaving the hospital.
Ask your child's healthcare provider about your child’s outlook. When this condition
is diagnosed early, the outcome is often excellent. The outlook may be poor when a
VSD is diagnosed later in life, if complications occur after surgery, or if the VSD
isn’t fixed. There is a risk for complications from a VSD. Children at risk for these
problems should have follow-up care at a center that specializes in congenital heart
disease.
When should I call my child's healthcare provider?
Call the healthcare provider if your child has:
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Trouble breathing
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Trouble eating
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Any new symptoms
Key points about VSD
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A VSD is an opening in the dividing wall between the 2 lower chambers of the heart.
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The size of the opening affects how severe your child’s symptoms are.
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Small VSDs may close on their as your child grows. If your child has a larger VSD,
he or she will likely need surgery or a cardiac catheterization to fix it.
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Most children whose defects close on their own or who have VSD repairs will live normal,
healthy lives.
Next steps
Tips to help you get the most from a visit to your child’s healthcare provider:
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Know the reason for the visit and what you want to happen.
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Before your visit, write down questions you want answered.
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At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
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Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
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Ask if your child’s condition can be treated in other ways.
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Know why a test or procedure is recommended and what the results could mean.
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Know what to expect if your child does not take the medicine or have the test or procedure.
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If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
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Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.