Ventricular Septal Defect (VSD)
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 one of the most common types of
congenital heart defects.
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 2 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
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 the VSD
is large, your child 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.
VSD may occur more often in some
families. This is because of gene problems. Most of the time, healthcare providers
don't know the cause of 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
larger opening, the heart and lungs have to work harder.
This can cause symptoms such
- Fast breathing
- Trouble breathing
- Pale skin
- Rapid heart rate
- Enlarged liver
- Poor feeding or tiring while
- Poor weight gain
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
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 pediatric cardiologist. This is a healthcare provider who
specializes in treating heart problems in children.
This provider will check your
child and listen to your child’s heart and lungs. The details about the murmur
will also help the provider make the diagnosis.
Tests may be needed to confirm
the diagnosis. The tests your child has depend on their age and condition, and the
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 pulmonary artery, left atrium, and left ventricle get more blood
than normal. There may also be changes in the lungs because of extra blood
This test records the
electrical activity of the heart. It also shows abnormal rhythms (arrhythmias)
and spots heart muscle stress.
An echocardiogram 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.
A cardiac MRI makes images of the body by using magnets and radio waves. It can
show the heart defect and how much blood flow is moving through the VSD.
Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
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 open heart surgery
or through procedures during cardiac catheterization. Once a child is diagnosed with
a VSD, their pediatric cardiologist 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
Babies with a larger VSD may
get tired when feeding. They may not be able to eat enough to gain weight. They
High-calorie formula or breastmilk. Your child
may need nutritional supplements added to their 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 feedings. Babies who can drink part of
their feeding may be fed the rest through a feeding tube. Infants who are
too tired to feed may get all of their nutrition through the feeding
Open Heart Surgery
The goal of open heart
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 cardiologist 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. Talk
with your child's healthcare provider for more information.
A VSD may also be fixed
during cardiac catheterization. In this procedure, a tool 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
provider closes the 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 doing transcatheter VSD repair.
Complications of an untreated
- Lung problems
- Heart failure
- Irregular heart rhythms
- Heart valve problems
- Poor growth and development
Babies with small VSDs may
have no symptoms. These children may not need medicine. They’ll still be checked
often. 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
Moderate to severe VSDs
If the VSD is moderate to
severe, your child will be monitored closely. Your child's healthcare provider
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 them 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. 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 may need 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
When to Call a Healthcare Provider
Call the healthcare provider if
your child has:
- Trouble breathing
- Trouble eating
- Any new symptoms
- 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 own
as your child grows. If the VSD is larger, your child 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
- 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.