About Ventricular Septal Defect (VSD)
What Is a Ventricular Septal Defect (VSD)?
Causes and Risk Factors of Ventricular Septal Defect
A ventricular septal defect (VSD) happens while a baby’s heart is forming during pregnancy. The wall between the two lower chambers of the heart does not fully develop, leaving one or more openings. In many cases, there is no clear cause. Researchers believe VSDs may develop because of a combination of genetic changes and other factors during pregnancy.
Risk factors that may increase the chance of VSD include:
- Family history or genetics: A baby may have a higher chance of a congenital heart defect if a parent or sibling has one. Some chromosome or genetic conditions, such as Down syndrome, can also be associated with VSD.
- Certain health conditions during pregnancy: Poorly controlled diabetes, phenylketonuria, or rubella infection during pregnancy may increase the risk of congenital heart defects.
Other factors during pregnancy may also affect risk, including:
- Smoking or secondhand smoke exposure during pregnancy.
- Use of certain medicines during pregnancy, such as some medicines for high blood pressure or acne. Anyone who is pregnant or planning pregnancy should talk with a healthcare professional before starting, stopping, or changing medicines.
Having one or more risk factors does not mean a baby will have a VSD. Many babies with VSD have no known risk factors, and many pregnancies with risk factors do not result in a heart defect. A healthcare professional can help explain individual risk and recommend any needed screening or follow-up.
Symptoms of Ventricular Septal Defect
Symptoms of a ventricular septal defect (VSD) depend on the size of the hole and whether there are other heart problems. A small VSD may not cause symptoms. Sometimes the only sign is a heart murmur, which is an extra sound a healthcare professional can hear with a stethoscope.
- Fast or heavy breathing, or shortness of breath.
- Tiring easily, especially during feeding or activity.
- Sweating during feeding.
- Trouble feeding or poor weight gain in babies.
- Slow growth or delayed weight gain.
- In larger or untreated VSDs, signs of heart failure may occur, such as trouble breathing, poor feeding, or swelling. Pulmonary hypertension can develop over time if extra blood flow to the lungs is not treated.
Contact a healthcare professional if a baby tires easily while feeding, is not gaining weight as expected, breathes fast, or seems short of breath. Seek urgent care for severe trouble breathing, blue or gray color around the lips or nails, fainting, or symptoms that suddenly worsen.
How Ventricular Septal Defect Is Diagnosed
A ventricular septal defect (VSD) may be found before birth, soon after birth, or later in childhood or adulthood. A healthcare professional may suspect a VSD after hearing a heart murmur or noticing symptoms such as fast breathing, poor feeding, or poor weight gain.
- Physical exam: The healthcare professional listens to the heart with a stethoscope to check for a heart murmur and looks for signs such as fast breathing, poor growth, swelling, or low oxygen levels.
- Echocardiogram: This ultrasound test uses sound waves to create moving pictures of the heart. It is the main test used to confirm a VSD, show where the hole is, estimate its size, and see how blood is flowing through the heart.
- Pulse oximetry: A small sensor estimates the oxygen level in the blood. Low oxygen can be a sign of a heart or lung problem.
- Electrocardiogram, also called an ECG or EKG: This quick, painless test records the heart’s electrical activity and can show heart rhythm or signs that the heart is working harder than usual.
- Chest X-ray: This imaging test can show whether the heart is enlarged or whether there is extra fluid or blood flow in the lungs.
- Cardiac MRI, CT scan, or cardiac catheterization: These tests are not needed for every person, but they may be used when more detail is needed about the heart, blood vessels, pressure, or oxygen levels.
The tests recommended depend on the person’s age, symptoms, exam findings, and whether other heart conditions are suspected. A pediatric cardiologist or cardiologist can explain which tests are needed and what the results mean.
Treatment for Ventricular Septal Defect
Treatment for a ventricular septal defect (VSD) depends on the size and location of the hole, the person’s symptoms, how much extra blood is flowing to the lungs, and whether the heart is working harder than usual. The goals of treatment are to support normal growth and activity, ease symptoms, and prevent complications.
- Regular checkups: Small VSDs may not need surgery or other treatment. Many small VSDs close on their own. A healthcare professional may recommend regular visits to check growth, listen for a heart murmur, and monitor the heart over time.
- Nutrition support: Some babies with larger VSDs use more energy because their heart and lungs are working harder. They may need higher-calorie feeds or extra feeding support to help them gain weight.
- Medicines: Medicines do not close a VSD, but they may help manage symptoms such as fluid buildup or signs of heart failure. For example, diuretics may help the body get rid of extra fluid. Other heart medicines may be used in some cases, depending on the person’s needs.
- Closure of the VSD: A medium or large VSD may need to be closed if it is causing symptoms, poor growth, heart enlargement, high blood flow to the lungs, or other complications. Closure is usually done with heart surgery using a patch or stitches. In selected cases, a catheter-based procedure may be an option, depending on the size and location of the VSD.
The best treatment plan is individualized. A pediatric cardiologist or cardiologist can explain whether watchful waiting, medicines, nutrition support, a procedure, or surgery is recommended.
Progression or Complications of Ventricular Septal Defect
How a ventricular septal defect (VSD) changes over time depends mainly on the size and location of the hole and whether it causes extra blood flow to the lungs. Many small VSDs cause few or no symptoms and may close on their own. Medium or large VSDs are more likely to need treatment because they can make the heart and lungs work harder.
- Small VSDs: These may close naturally during childhood or remain small without causing major problems. Ongoing follow-up may still be recommended, especially for certain types of VSD.
- Medium or large VSDs: These can send too much blood to the lungs. Over time, this may lead to poor growth, heart enlargement, heart failure symptoms, or high blood pressure in the lung arteries, called pulmonary hypertension.
- Untreated large VSDs: If a large VSD is not treated, long-term high pressure in the lung blood vessels can sometimes cause permanent lung blood vessel damage. In rare cases, this can lead to Eisenmenger syndrome, a serious condition in which blood flow through the heart defect changes direction and oxygen levels in the body may become low.
- After repair: Most people do well after VSD repair, but follow-up is still important. Possible issues after repair can include a small remaining leak, heart rhythm problems, valve leakage, or narrowing near the repair area.
Possible complications of VSD can include:
- Heart failure symptoms, especially in babies with larger VSDs.
- Pulmonary hypertension, which means high blood pressure in the arteries of the lungs.
- Eisenmenger syndrome, which is rare but serious and can occur after long-term untreated pulmonary hypertension.
- Irregular heart rhythms, also called arrhythmias.
- Heart valve problems, such as leakage of the aortic valve in some types of VSD.
- Infective endocarditis, a rare infection of the inner lining of the heart.
- Stroke, which is uncommon but may occur in some people with complications or certain blood-flow patterns.
Complications are less common with small VSDs and with VSDs that are repaired before they cause long-term heart or lung problems. Because every case is different, regular follow-up with a heart specialist can help monitor the VSD, guide treatment decisions, and check for complications over time.