A ventricular septal defect (VSD) is a congenital heart defect. This means that your baby is born with it. A VSD is an opening or hole in the dividing wall (septum) between the 2 lower chambers of the heart (right and left ventricles). VSDs are the most common type of congenital heart defect.
A VSD allows oxygen-rich (red) blood to pass from the left ventricle through the opening in the septum. Then it mixes with oxygen-poor (blue) blood in the right ventricle.
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.
VSD may occur more often in some families. This is because of gene defects. Most of the time, the cause of VSD isn’t known.
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. The larger the opening, the more blood passes through it. The right ventricle and lungs have to work harder.
Your child may have symptoms from birth. Or your child may not have symptoms until he or she is a little older. Symptoms can occur a bit differently in each child. They can include:
- Fast breathing
- Trouble breathing
- Pale skin
- Rapid heart rate
- Enlarged liver
- Poor feeding or tiring while feeding
- Poor weight gain
The symptoms of VSD may be similar to symptoms of other conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
Your child's healthcare provider may suspect a problem when he or she hears 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 baby. 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.
Your child’s 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.
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.
This test records the electrical activity of the heart. It also shows abnormal rhythms (arrhythmias) and spots heart muscle stress.
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 often used to diagnose VSD.
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, his or her heart doctor will check the defect regularly to see if it’s closing on its own.
Some children may need to take medicine to help the heart work better. Children without symptoms may not need medicine.
Infants with a larger VSD may get tired when feeding. They may not be able to eat enough to gain weight. They may need:
- 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.
- 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. Infants 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.
The goal of surgery is to repair the septal opening before the lungs are damaged. Surgery will also help infants 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.
VSD may be repaired by a cardiac catheterization. In this test, an instrument called a septal occluder is used with a catheter. The healthcare provider 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.
Complications of an untreated VSD include:
- Lung problems
- Heart failure
- Irregular heart rhythms (arrhythmias)
- Heart valve problems
- Poor growth and development
Infants 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 2 years of age. But some defects don’t close until 4 years of age. 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. When a VSD is diagnosed later in life, if complications occur after surgery, or if the VSD isn’t repaired, the outlook may be poor. 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.
If your child has trouble breathing or eating, or develops any new symptoms, call his or her healthcare provider.
- A VSD is an opening in the dividing wall between the 2 lower chambers of the heart.
- The size of the opening affects how severe your child’s symptoms are.
- 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.
- Most children whose defects close on their own or who have VSD repairs will live normal, healthy lives.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- 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.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- 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.
January 16, 2018
Pathophysiology and clinical features of isolated ventricular septal defects in infants and children. UpToDate., VSD. Bernstein Daniel. Nelson Textbook of Pediatrics. 2011;19:1556–1558. Chpt 420.6., Isolated Ventricular Septal Defect. Webb Gary D. Braunwald's Heart Disease - A Textbook of Cardiovascular Medicine. 2011;9:1430–1432. Chpt 65., Management of isolated ventricular septal defects in infants and children, Up Tp Date
Ayden, Scott, MD,Bass, Pat F., III, MD, MPH