Overview

A ventricular septal defect (VSD), a hole in the heart, is a common heart defect that's present at birth (congenital). The hole (defect) occurs in the wall (septum) that separates the heart's lower chambers (ventricles) and allows blood to pass from the left to the right side of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to work harder.

A small ventricular septal defect may cause no problems, and many small VSDs close on their own. Medium or larger VSDs may need surgical repair early in life to prevent complications.

Symptoms

Signs and symptoms of serious heart defects often appear during the first few days, weeks or months of a child's life.

Ventricular septal defect (VSD) symptoms in a baby may include:

·         Poor eating, failure to thrive

·         Fast breathing or breathlessness

·         Easy tiring

You and your doctor may not notice signs of a ventricular septal defect at birth. If the defect is small, symptoms may not appear until later in childhood — if at all. Signs and symptoms vary depending on the size of the hole and other associated heart defects.

Your doctor may first suspect a heart defect during a regular checkup if he or she hears a murmur while listening to your baby's heart with a stethoscope. Sometimes VSDs can be detected by ultrasound before the baby is born.

Sometimes a VSD isn't detected until a person reaches adulthood. Symptoms and signs can include shortness of breath or a heart murmur your doctor hears when listening to your heart with a stethoscope.

When to see a doctor

Call your doctor if your baby or child:

·         Tires easily when eating or playing

·         Is not gaining weight

·         Becomes breathless when eating or crying

·         Breathes rapidly or is short of breath

Call your doctor if you develop:

·         Shortness of breath when you exert yourself or when you lie down

·         Rapid or irregular heartbeat

·         Fatigue or weakness

Causes

Congenital heart defects arise from problems early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role. VSDs can occur alone or with other congenital heart defects.

During fetal development, a ventricular septal defect occurs when the muscular wall separating the heart into left and right sides (septum) fails to form fully between the lower chambers of the heart (ventricles).

Normally, the right side of the heart pumps blood to the lungs to get oxygen; the left side pumps the oxygen-rich blood to the rest of the body. A VSD allows oxygenated blood to mix with deoxygenated blood, causing the heart to work harder to provide enough oxygen to the body's tissues.

VSDs may be various sizes, and they can be present in several locations in the wall between the ventricles. There may be one or more VSD.

It's also possible to acquire a VSD later in life, usually after a heart attack or as a complication following certain heart procedures.

Risk factors

Ventricular septal defects may run in families and sometimes may occur with other genetic problems, such as Down syndrome. If you already have a child with a heart defect, a genetic counselor can discuss the risk of your next child having one.

Complications

A small ventricular septal defect may never cause any problems. Medium or large defects can cause a range of disabilities — from mild to life-threatening. Treatment can prevent many complications.

·         Heart failure. In a heart with a medium or large VSD, the heart needs to work harder to pump enough blood to the body. Because of this, heart failure can develop if medium to large VSDs aren't treated.

·         Pulmonary hypertension. Increased blood flow to the lungs due to the VSD causes high blood pressure in the lung arteries (pulmonary hypertension), which can permanently damage them. This complication can cause reversal of blood flow through the hole (Eisenmenger syndrome).

·         Endocarditis. This heart infection is an uncommon complication.

·         Other heart problems. These include abnormal heart rhythms and valve problems.

Prevention

In most cases, you can't do anything to prevent having a baby with a ventricular septal defect. However, it's important to do everything possible to have a healthy pregnancy. Here are the basics:

·         Get early prenatal care, even before you're pregnant. Talk to your doctor before you get pregnant about your health and discuss any lifestyle changes that your doctor may recommend for a healthy pregnancy. Also, be sure you talk to your doctor about any medications you're taking.

·         Eat a balanced diet. Include a vitamin supplement that contains folic acid. Also, limit caffeine.

·         Exercise regularly. Work with your doctor to develop an exercise plan that's right for you.

·         Avoid risks. These include harmful substances such as alcohol, tobacco and illegal drugs.

·         Avoid infections. Be sure you're up to date on all of your vaccinations before becoming pregnant. Certain types of infections can be harmful to a developing fetus.

·         Keep diabetes under control. If you have diabetes, work with your doctor to be sure it's well-controlled before getting pregnant.

If you have a family history of heart defects or other genetic disorders, consider talking with a genetic counselor before getting pregnant.

Diagnosis

Ventricular septal defects (VSDs) often cause a heart murmur that your doctor can hear using a stethoscope. If your doctor hears a heart murmur or finds other signs or symptoms of a heart defect, he or she may order several tests including:

·         Echocardiogram. In this test, sound waves produce a video image of the heart. Doctors may use this test to diagnose a ventricular septal defect and determine its size, location and severity. It may also be used to see if there are any other heart problems. Echocardiography can be used on a fetus (fetal echocardiography).

·         Electrocardiogram (ECG). This test records the electrical activity of the heart through electrodes attached to the skin and helps diagnose heart defects or rhythm problems.

·         Chest X-ray. An X-ray image helps the doctor view the heart and lungs. This can help doctors see if the heart is enlarged and if the lungs have extra fluid.

·         Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or arm and guided through the blood vessels into the heart. Through cardiac catheterization, doctors can diagnose congenital heart defects and determine the function of the heart valves and chambers.

·         Pulse oximetry. A small clip on the fingertip measures the amount of oxygen in the blood.

Treatment

Many babies born with a small ventricular septal defect (VSD) won't need surgery to close the hole. After birth, your doctor may want to observe your baby and treat symptoms while waiting to see if the defect closes on its own.

Babies who need surgical repair often have the procedure in their first year. Children and adults who have a medium or large ventricular septal defect or one that's causing significant symptoms may need surgery to close the defect.

Some smaller ventricular septal defects are closed surgically to prevent complications related to their locations, such as damage to heart valves. Many people with small VSDs have productive lives with few related problems.

Babies who have large VSDs or who tire easily during feeding may need extra nutrition to help them grow. Some babies may require tube feeding.

Medications

Medications for ventricular septal defect may include those to:

·         Decrease the amount of fluid in circulation and in the lungs. Doing so reduces the volume of blood that must be pumped. These medications, called diuretics, include furosemide (Lasix).

·         Keep the heartbeat regular. Examples include beta blockers, such as metoprolol (Lopressor), propranolol (Inderal LA) and others, and digoxin (Lanoxin, Lanoxin Pediatric).

Procedures

Surgical treatment for ventricular septal defects involves plugging or patching the abnormal opening between the ventricles. If you or your child is having surgery to repair a ventricular defect, consider having surgery performed by surgeons and cardiologists with training and expertise in conducting these procedures. Procedures may include:

·         Surgical repair. This procedure of choice in most cases usually involves open-heart surgery under general anesthesia. The surgery requires a heart-lung machine and an incision in the chest. The doctor uses a patch or stitches to close the hole.

·         Catheter procedure. Closing a ventricular septal defect during catheterization doesn't require opening the chest. Rather, the doctor inserts a thin tube (catheter) into a blood vessel in the groin and guides it to the heart. The doctor then uses a specially sized mesh device to close the hole.

·         Hybrid procedure. A hybrid procedure uses surgical and catheter-based techniques. Access to the heart is usually through a small incision, and the procedure may be performed without stopping the heart and using the heart-lung machine. A device closes the ventricular septal defect via a catheter placed through the incision.

After repair, your doctor will schedule regular medical follow-up to ensure that the ventricular septal defect remains closed and to look for signs of complications. Depending on the size of the defect and the presence of other problems, your doctor will tell you how frequently you or your child will need to be seen.