- Ventricular septal defect (VSD) is a type of congenital heart defect.
- Your heart has two sides, separated by an inner wall called the septum. A ventricular septal defect (VSD) is a hole in the lower part of the septum, which separates the right and left ventricles.
Figure shows the structure and blood flow inside a normal heart. Figure B shows two common locations for a ventricular septal defect. The defect allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle.
- Ventricular septal defects can be small or large. Many small VSDs close on their own as the heart grows during childhood. Large holes in the septum are less likely to close on their own over time.
- A heart murmur (an extra or unusual sound heard during a heartbeat) is the most common sign of a ventricular septal defects.
- If a VSD causes heart failure, signs and symptoms may include fatigue (tiredness), tiring easily during physical activity, shortness of breath, a buildup of blood and fluid in the lungs, and a buildup of fluid in the feet, ankles, and legs.
- Doctors usually diagnose holes in the heart based on results from a physical exam and tests and procedures. Ventricular septal defects have a very distinct heart murmur, so a diagnosis usually is made in infancy.
- The outlook for children who have ventricular septal defectss is excellent. Advances in treatment allow most children who have these heart defects to live normal, active, and productive lives with no decrease in lifespan.
- Many children who have Ventricular septal defects need no special care or only occasional checkups with a cardiologist (heart specialist) as they go through life.
An infant who is born with a VSD may have a single hole or more than one hole in the wall that separates the two ventricles. The defect also may occur by itself or with other congenital heart defects.
Doctors classify ventricular septal defects based on the:
- Size of the defect.
- Location of the defect.
- Number of defects.
- Presence or absence of a ventricular septal aneurysm—a thin flap of tissue on the septum. This tissue is harmless and can help a VSD close on its own.
VSDs can be small or large. Small VSDs don't cause problems and often may close on their own. Because small VSDs allow only a small amount of blood to flow between the ventricles, they're sometimes called restrictive VSDs. Small VSDs don't cause any symptoms.
Medium VSDs are less likely to close on their own and may require heart surgery. Medium VSDs are also more likely to cause symptoms during infancy and childhood.
Large VSDs allow a large amount of blood to flow from the left ventricle to the right ventricle. They're sometimes called nonrestrictive VSDs. A large VSD is less likely to close completely on its own, but it may get smaller over time. Large VSDs often cause symptoms in infants and children, and surgery usually is needed to close them.
Ventricular septal defects are found in different parts of the septum.
- Membranous VSDs are located near the heart valves. These VSDs can close at any time.
- Muscular VSDs are found in the lower part of the septum. They're surrounded by muscle, and most close on their own during early childhood.
- Inlet VSDs are located close to where blood enters the ventricles. They're less common than membranous and muscular VSDs.
- Outlet VSDs are found in the part of the ventricle where blood leaves the heart. These are the rarest type of VSD.
Ventricular Septal Defect Complications
Over time, if a ventricular septal defects isn't repaired, it may cause heart problems. A moderate to large VSD can cause:
- Heart failure. Infants who have large VSDs may develop heart failure because the left side of the heart pumps blood into the right ventricle in addition to its normal work of pumping blood to the body. The increased workload on the heart also increases the heart rate and the body's demand for energy.
- Growth failure, especially in infancy. A baby may not be able to eat enough to keep up with his or her body's increased energy demands. As a result, the baby may lose weight or not grow and develop normally.
- Heart arrhythmias (irregular heartbeats). The extra blood flowing through the heart can cause areas of the heart to stretch and enlarge. This can disturb the heart's normal electrical activity, leading to arrhythmias.
- Pulmonary hypertension (PH). The high pressure and high volume of extra blood pumped through a large VSD into the right ventricle and lungs can scar the lung's delicate arteries. Today, PH rarely develops because most large VSDs are repaired in infancy.
What Are the Signs and Symptoms of Ventricular Septal Defects?
A heart murmur usually is present in ventricular septal defect (VSD), and it may be the first and only sign of this defect. Heart murmurs often are present right after birth in many infants. However, the murmurs may not be heard until the babies are 6 to 8 weeks old.
Most newborns who have VSDs don't have heart-related symptoms. However, babies who have medium or large VSDs can develop heart failure. Signs and symptoms of heart failure usually occur during the baby's first 2 months of life.
The signs and symptoms of heart failure from VSD are similar to those listed above for ASD, but they occur in infancy.
A major sign of heart failure in infancy is difficulty feeding and poor growth. VSD signs and symptoms are rare after infancy because the defect either decreases in size on its own or is repaired.
How Are Ventricular Septal Defects Diagnosed?
During a physical exam, your child's doctor will listen to your child's heart and lungs with a stethoscope. The doctor also will look for signs of a heart defect, such as a heart murmur or signs of heart failure.
Echocardiography is a painless test that uses sound waves to create a moving picture of the heart. ECHO is an important test for both diagnosing a hole in the heart and following the problem over time. ECHO can show problems with the heart's structure and how the heart is reacting to the problems. ECHO will help your child's cardiologist decide whether and when treatment is needed.
An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through each part of the heart.
An EKG can detect whether one of the heart's chambers is enlarged, which can help diagnose a heart problem.
Chest X Ray
A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged or whether the lungs have extra blood flow or extra fluid, a sign of heart failure.
Pulse oximetry shows how much oxygen is in the blood. For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood.
During cardiac catheterization, a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck and threaded to the heart.
Special dye is injected through the catheter into a blood vessel or a chamber of the heart. The dye allows the doctor to see the flow of blood through the heart and blood vessels on an x-ray image.
The doctor also can use cardiac catheterization to measure the pressure inside the heart chambers and blood vessels. This can help the doctor determine whether blood is mixing between the two sides of the heart.
How Are Ventricular Septal Defects Treated?
Doctors may choose to monitor and observe children who have ventricular septal defects but don't have symptoms of heart failure. This means regular checkups and tests to see whether the defect closes on its own or gets smaller.
More than half of ventricular septal defects eventually close, usually by the time a child is in preschool. Your child's doctor will let you know how often your child should be checked. Checkups may range from once a month to once every 1 or 2 years.
When treatment for a VSD is required, options include extra nutrition and surgery to close the VSD.
The doctor may recommend surgery if your child's VSD:
- Is large
- Is causing symptoms
- Is medium-sized and is causing enlarged heart chambers
- Affects the aortic valve
Some infants who have VSDs don't grow and develop or gain weight as they should. These infants usually:
- Have large VSDs
- Are born prematurely
- Tire easily during feeding
Doctors usually recommend extra nutrition or special feedings for these infants. These feedings are high-calorie formulas or breast milk supplements that give babies extra nourishment.
In some cases, tube feeding is needed. Food is given through a small tube that's placed through the nose and into the stomach. Tube feeding can add to or take the place of bottle feeding. This treatment usually is temporary because a VSD that causes symptoms will likely need surgery.
Most doctors recommend heart surgery to close large VSDs that are causing symptoms or haven't closed by the time children are 1 year old. Surgery may be needed earlier if:
- The child fails to gain weight
- Medicines are needed to control the symptoms of heart failure
Rarely, medium-sized VSDs that are causing enlarged heart chambers are treated with surgery after infancy. However, most VSDs that need surgery are repaired in the first year of life.
Living With Ventricular Septal Defects
The outlook for children who have ventricular septal defects (VSDs) is excellent. Advances in treatment allow most children who have these heart defects to live normal, active, and productive lives with no decrease in lifespan.
Many children who have these defects need no special care or only occasional checkups with a cardiologist (a heart specialist) as they go through life.
Children and adults who've had successful repair of VSDs and have no other congenital heart defects can expect to lead normal, healthy, and active lives.
Sometimes problems and risks remain after surgical closure. They include:
- Arrhythmias. Serious and frequent arrhythmias require regular medical followup. The risk of arrhythmia is greater if surgery is done later in life.
- Residual or remaining VSD. This usually is due to a leak at the edge of the patch used to close the hole. These VSDs tend to be very small and don't cause problems. They very rarely require another operation.
Children who have severe heart defects may be at slightly increased risk for baterial or infective endocarditis (IE), a serious infection of the inner lining of your heart chambers and valves.
In a few situations, your child's doctor or dentist may give your child antibiotics before medical or dental procedures (such as surgery or dental cleanings) that could allow bacteria into the bloodstream. Your child's doctor will tell you whether your child needs to take antibiotics before such procedures.
To reduce the risk of infective endocarditis, gently brush your young child's teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child's doctor and dentist about how to keep your child's mouth and teeth healthy.
Special Considerations for Children and Teens
- Activity. Children who have small VSDs that don't require surgery or who have recovered from VSD repair shouldn't have activity restrictions. Be sure to check with your child's doctor about whether your child can take part in sports.
- Growth and development. Your pediatrician or family doctor will check your child's growth and development at each routine checkup. Babies who have large VSDs may not grow as quickly as other infants. These babies usually catch up after their VSDs are closed.
- Regular health care. Your child should see his or her regular doctor for routine health care.
- Additional surgery or procedures. Teens and young adults rarely need additional surgeries once VSDs are closed or repaired.
Reference: The National Heart Lung and Blood Institute
Last updated April 27, 2017