A ventricular septal defect (VSD) is a common congenital heart defect where the septum dividing the heart’s pumping chambers is incomplete, causing a hole. Large VSDs can cause immediate problems, while small ones may close on their own. Diagnosis involves non-invasive tests, and moderate to large VSDs may require surgery. There is no known definitive cause for VSDs.
A ventricular septal defect (VSD) is one of the most common congenital heart defects. A wall or septum divides the ventricles, the pumping chambers of the heart. In some developing hearts, the septum does not completely divide the two ventricles. A hole in the septum is classified as a ventricular septal defect. Many may have heard the term “hole in the heart,” which usually refers to a VSD.
If a VSD is large enough, it can cause almost immediate problems for the affected infant. VSDs create problems because blood returning to the lungs in the right ventricle mixes with oxygenated blood in the left ventricle. This can overload the right ventricle and send too much blood to the lungs, causing very high blood pressure. If ignored, a VSD can cause a syndrome called Eisenmenger, which results in early morbidity and is only repairable through a heart-lung transplant.
The mixed blood returning to the body from the left ventricle causes all the tissues and organs in the body to not get enough oxygen. This can cause growth problems, feeding difficulties, and gradually an enlarged heart, due to the body’s attempt to get more oxygen. Both ventricles may enlarge due to overflow.
Fortunately, the ventricular septal defect is often so small that it may never be noticed or treated. Often a small VSD closes on its own without any kind of medical intervention. Moderate-sized VSDs are usually first noticed a few days after a child is born, although diagnosis may take longer depending on the impact of the ventricular septal defect on the child’s health. Many children with minor VSDs don’t show any symptoms or problems, but doctors can detect a heart murmur, which warrants further investigation.
When a ventricular septal defect is suspected, the child is usually referred to a pediatric cardiologist for further testing. Your cardiologist will likely order a chest X-ray, an electrocardiogram (ECG), and an echocardiogram. The echocardiogram is basically a sonogram of the heart. All of these tests are non-invasive and take little time to perform. If further examination of the size of the ventricular septal defect is needed, cardiac catheterization may be performed.
With a moderately sized ventricular septal defect, most cardiologists prefer to wait and see if the hole closes on its own. This decision varies, however, and depends largely on the health of the child. The bigger the hole, the more problems you will experience.
If VSD repair isn’t immediate, your cardiologist may prescribe medications such as digoxin to improve heart function and lasix to help reduce fluid overload. When a baby cannot breastfeed or bottle feed, high-calorie formula can be given through a nasogastric tube. A child with an unrepaired moderate or large VSD is more susceptible to lung infections and care should be taken to avoid exposure to other sufferers.
If a ventricular septal defect causes significant growth retardation or creates too much pressure in the lungs, surgical repair provides an excellent outcome. The pediatric cardiothoracic surgeon will perform an open-heart procedure and suture or patch the holes with Gore-tex. Once the surgery has been performed, the child may be monitored once a year, but generally there are no restrictions on activity or effect on quality of life. Most cardiologists, however, recommend that any child with a ventricular septal defect, repaired or not, take antibiotics before any dental exams to inhibit the potential growth of strep cells in the heart, a condition called bacterial endocarditis.
While the surgery itself can be scary and stressful for both the parents and the child, once it is done, the child should live a normal, healthy life. Symptoms before surgery, such as poor growth or feeding problems, usually resolve once the ventricular septal defect closes. Shutting down a single VSD has a 99% chance of being uncomplicated.
In general, there is no known cause for a VSD. Children with Down syndrome are more likely to have a VSD, as are children with Noonan syndrome. Maternal use of alcohol and cocaine has also been linked to a higher incidence of VSD. However, in most cases of ventricular septal defect, there is no definitive link to maternal behavior or related health problems.
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