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 the most common type of congenital heart
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 two 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 your
child has a larger VSD, he or she 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, doctors 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 a
larger opening, the heart and lungs have to work harder.
This can cause symptoms such as
- 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 heart doctor for children (pediatric cardiologist).
The heart doctor will check your
child. 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.
The heart 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 used
to diagnose 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 surgery or through
cardiac catheterization. Once a child is diagnosed with a VSD, their 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
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
his or her formula or pumped breastmilk. This increases the number of
calories in each ounce.
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.
Babies 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
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
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 fixed by a
cardiac catheterization. In this test, a tool called a septal occluder is used
with a catheter. The doctor 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. Only certain types of VSDs may be closed with this method.
This procedure should be done in centers that have staff with experience in
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 by their heart doctors. 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 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. 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 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
- 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.